198602950-5-2-2024-28-AS-WSHO-D52UL3-20240507154001

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 05/02/2024
Date Signed: 05/02/2024 12:04:37 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
04/25/2024 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240425122625

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:	05/02/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Assistant Administrator, Cynthia Flores		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff do not practice safe food handling techniques

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 9:40 AM to 10:05 AM.
Interviews were conducted with Residents R1-R8 from 10:10 AM to 11:00 AM.
Tour of the kitchen and dining room area which included observation of dining room and observation of the kitchen which includes the food supply.
In regards to the allegation Staff do not practice safe food handling techniques, based on tour conducted, interviews conducted and information gathered, LPA observed in the dining room that the servers were wearing gloves. Observation in the kitchen was that staff wore gloves. There was no food left on any of the counters in the kitchen and in the freezer there were no perishables left unopened.
There were 5 boxes of gloves observed in the kitchen area.

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: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

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-20240425122625

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: 05/02/2024

NARRATIVE

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Interviews were conducted with Resident's R1-R8 and 7 of the 8 stated that staff do wear gloves when serving food. 1 of the 8 stated she doesn't pay attention if they wear it or not.
8 of 8 resident's stated that they have never had any food served that is uncooked or raw and that it is always served well.
6 of 8 resident's stated that the food was good and that it has gotten better. 2 of the 8 resident's stated they prefer getting their own food for their meals.
Interviews were conducted with staff who all stated that the there is not chicken left on the counter. All stated that it is served fresh after cooking in the oven. Also stated that food from oven is put in steamer 10 minutes before being served and food is never cooked on the steamer.
LPA observed steamer with no food being cooked in it.
Staff also stated that gloves are worn in the kitchen and when serving food.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

Exit interview was conducted with Assistant Administrator, Cynthia Flores.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

LIC9099 (FAS) - (06/04)

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