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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 05/13/2024
Date Signed: 05/13/2024 02:48:08 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/09/2024 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240509125328
FACILITY NAME:LAKEWOOD PARK MANORFACILITY NUMBER:
198602950
ADMINISTRATOR:NARINE MERTKHANYANFACILITY TYPE:
740
ADDRESS:12045 LAKEWOOD BLVDTELEPHONE:
(562) 923-4417
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:160CENSUS: 120DATE:
05/13/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Narine MertkhanyanTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Communications of resident's authorized representative are not being answered promptly by facility staff
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Executive Director Narine Mertkhanyan and explained the reason for the visit.

The investigation consisted of the following: LPA conducted interviews with Executive Director Narine Mertkhanyan, Staff 1-3 (S1-3) and Residents 1-8 (R1-8). LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1's facility file and collected copies of documents pertinent to the complaint investigation.



(See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024
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-20240509125328
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: LAKEWOOD PARK MANOR
FACILITY NUMBER: 198602950
VISIT DATE: 05/13/2024
NARRATIVE
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Investigation revealed the following: Regarding allegation, Communications of resident's authorized representative are not being answered promptly by facility staff, it is alleged that R1 wants to move out of the facility for unknown reasons and numerous attempts to get in contact with facility management regarding this request have gone unanswered and phone calls have not been returned since approximately 02/29/24. Allegedly the facility receptionist has taken contact information down but R1's family member (R1 FM) has not received a call back and due to this lack in communication R1's FM is concerned regarding R1's safety and care. Interviews conducted with Executive Director Narine Mertkhanyan and S1-3 revealed that facility staff have not received messages from R1 FM. Executive Director Narine Mertkhanyan and S1 stated that R1 is self-responsible and has not spoken to staff about moving out of the facility. They stated that R1 has spoken to staff about moving rooms but not about moving out of the facility. S2 stated that R1 has mentioned that they might move somewhere else to be closer to family but R1 has not talked to Executive Director or S1 as they are the staff that would assist R1 with moving out. Staff stated that when they receive messages for any resident, staff ensure that the messages are delivered to them in a timely manner. They stated that most residents have their own personal phones and might use their phones to return calls. They stated that the facility phone is always available for resident use. Staff stated that resident safety is a top priority and they have not received any concerns from anyone regarding concerns with resident safety or care. Staff stated that all residents receive adequate care and that there is enough staffing throughout the day to ensure that residents are receiving appropriate care and supervision. S2 stated that when they take a message down it is forwarded to the appropriate staff for follow up. Interview conducted with R1 revealed that they are self-responsible and have thought about moving to another facility to be closer to family but they have not decided where so they have not spoken to management about that yet. R1 stated that they did speak to staff about moving rooms and staff assisted them with that request. R1 stated that they do not have concerns regarding communications, safety or care. Interviews with 8 out of 8 residents revealed that they are satisfied with the services that they receive at the facility and do not have any concerns regarding communication, safety or care. They stated that staff give them their messages whenever they have any. LPA review of R1 file revealed that R1 is self-responsible. LPA reviewed Facility Personnel Report (LIC500) which revealed that the facility is properly staffed to oversee and provide care for the residents in placement. Based on interviews conducted with facility staff, facility residents, and LPA review of documents there was not enough supportive evidence to concur with the reported allegation.

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.

Exit interview held. A copy of the report was provided to Executive Director Narine Mertkhanyan.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024
LIC9099 (FAS) - (06/04)
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