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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 08/15/2024
Date Signed: 08/15/2024 05:20:50 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
08/07/2024 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20240807142151
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:
08/15/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Assistant Administrator, Cynthia FloresTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Facility staff is mishandling residents money.
Facility staff not allowing resident to receive phone calls.
Facility staff not allowing resident to receive mail.
Facility staff not allowing resident to leave the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation visit regarding the above allegations. LPA Margaryan met with Assistant Administrator, Cynthia Flores and explained the reason for the visit.

The investigation consisted of the following: LPA conducted interviews with Assistant Administrator,Staff 1-Staff 2 (S1-S2) and Residents 2-Residfent 13 (R2-R13). R1 was not interviewed as resident is currently in the hospital. LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1's facility file and collected copies of documents pertinent to the complaint investigation.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune MargaryanTELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 28-AS-20240807142151
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: 08/15/2024
NARRATIVE
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The investigation revealed the following. Regarding Allegation: Facility staff is mishandling residents money. It was reported that R1 does not have enough money in their account and owes the facility over $1000.00.
Record review confirm that R1 was admitted to the facility on 12/20/23. R1 transferred to the facility from SNF. Interviewed Assistant administrator stated that if the resident transferred from SNF, income verification is done prior to transfer and if there is an overpayment on SSI record, they discuss the payment options with resident. Facility records indicated that R1 doesn't have conservator and the facility is the payee for R1.
LPA observed that Admission agreement was signed by R1 with the monthly rate $1344.82 for basic services on 12/20/23. On January 2024 R1's rent was increased to $1418.07 and notice of increase was provided to R1 (copy was provided to LPA). However, R1 doesn't paid the rent until 06/03/24 when funds become available for R1. Total amount for the rent since R1 was admitted to the facility was $11,865.13. As of today, facility received the total amount of $9,086.31 and record review reveals that R1 owes $2,258.25 to the facility. Assistant Administrator stated that the facility has developed a payment plan for R1, due to the fact that R1 has an outstanding balance and is not current on their rent. R1 was agreed to pay amount that they own the facility. R1 will pay $89.00 every month until the balance is paid in full.

Regarding Allegations: Facility staff not allowing resident to receive phone calls and
Facility staff not allowing resident to receive mail. It was alleged that facility declining calls for R1 and R1 not receiving mails. Interviewed Assistant Administrator and staff denied the allegations. They stated staff are ensuring that residents are receiving phone calls. Staff stated when residents are receiving a phone calls, staff is locating the residents and they can speak on the phone to the caller. At times, staff take a message for a call back per resident request, caller request or if a resident is out of the building and give the message upon return. They stated that they didn't decline any phone calls for R1 or other residents. Per Assistant administrator and staff, clients are given their mails when they are sent to them. Staff interviews revealed that when mail comes to residents, the mail is sorted according to the room number and is promptly delivered to the resident. Staff denied that they have failed to ensure that R1, or any resident, received their mail. Resident interviews revealed that residents are receiving phone calls and also receiving their mail on time and had no issues with postal mail correspondence at the facility.

Continue 9099C
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune MargaryanTELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240807142151
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: 08/15/2024
NARRATIVE
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Regarding Allegations: Facility staff not allowing resident to leave the facility. It was alleged that R1 cannot leave the facility and someone else leave and do her shopping and have someone else doing her errands.
Interviewed Assistant administrator and staff denied the allegation. Interviews revealed that residents are allowed to leave the facility either with assistance or without assistance based on physician's orders. If assistance is required for transportation staff will help assisting book via Access, Dial a Ride, Taxi for medical appointments, or facility transportation, companionship to outing will be arranged also with staff. Record review shows that R1 able to leave the facility with assistance. Staff stated if R1 needs to go for shopping staff will assist him/her. So far R1 hasn't said he/she needs someone to help him/her for shopping or doing his/her errands. Interviewed residents confirmed that they can leave the facility if they want. They stated that they let the staff know and sign out and sign in upon return.

Based on interviews, file review; although the allegation(s) 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. A copy of the report was issued.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune MargaryanTELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
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