198602950-3-7-2024-28-AS-RORN-D3QL8N-20240326083210

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 03/07/2024
Date Signed: 03/07/2024 12:11:08 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/01/2024 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240301161357

FACILITY NAME:	LAKEWOOD PARK MANOR		FACILITY NUMBER:	198602950
ADMINISTRATOR:	LISA PHAM		FACILITY TYPE:	740
ADDRESS:	12045 LAKEWOOD BLVD		TELEPHONE:	(562) 923-4417
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	160	CENSUS: 106	DATE:	03/07/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Assistant Administrator, Cynthia Flores		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff refused to accept resident in to the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted the initial complaint investigation for the allegation listed above. LPA arrived unannounced and met with Assistant Administrator, Cynthia Flores. The purpose of the visit was discussed.
During the visit today, LPA obtained copies of the staff roster and resident roster.
Interviews with Assistant Administrator and Staff S1 and S2 were conducted from 10:00AM to 11:15 AM.
Interview was conducted with Resident R 1 telephonically on 03/04/2024.
In regards to the allegation Staff refused to accept resident in to the facility, based on interviews conducted and information gathered it was revealed in interviews with staff that R 1 was never admitted to the facility because he refused to pay the 1st month's rent and was very upset and yelling. Staff stated that R 1 was given the wrong information from the Social Worker from Skilled Nursing.
LPA observed an e-mail exchange between the Social Worker from Skilled Nursing and the representative from the Assisted Living Waiver Program. The Social Worker stated that it was her understanding that the first month's rent was paid and was not aware that R 1 has to wait 6 months before the funding is in

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240301161357

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LAKEWOOD PARK MANOR	FACILITY NUMBER: 198602950
	VISIT DATE: 03/07/2024

NARRATIVE

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process.
Interview with Staff Marketer who stated that they had done everything correctly, but R 1 was upset over the money.
Stated that R 1 left the office without signing the Admissions Agreement.
Also stated that it was explained the facility has to follow the diet through the ALW Program. Stated they did attempt to send R 1 back to his skilled nursing, but they would not accept him back.
Interview was conducted with R 1 who stated that the staff member tried taking R 1 back to the skilled nursing, but they refused to take him back.
Also stated that he was unaware of a $49 prorated charge and that facility was seeking $1000 before move in, but he decided to wait.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC9099 (FAS) - (06/04)

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