198602950-10-8-2024-28-AS-RORN-DAKSNE-20241031140125

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 10/08/2024
Date Signed: 10/08/2024 05:16:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
10/03/2024 and conducted by Evaluator Tyler Reyes

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241003094717

FACILITY NAME:	LAKEWOOD PARK MANOR		FACILITY NUMBER:	198602950
ADMINISTRATOR:	NARINE MERTKHANYAN		FACILITY TYPE:	740
ADDRESS:	12045 LAKEWOOD BLVD		TELEPHONE:	(562) 923-4417
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	160	CENSUS: 120	DATE:	10/08/2024
		UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Assistant Administrator, Cynthia Flores		TIME COMPLETED:	05:20 PM

ALLEGATION(S):

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Staff did not prevent a resident from physically assaulting another resident in care.
Facility did not maintain a comfortable temperature for a resident in care.

INVESTIGATION FINDINGS:

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On today’s visit, Licensing Program Analyst(LPA) Tyler Reyes met with Assistant Administrator Cynthia Flores and explained the reason for the visit and obtained a copy of the staff and resident roster.

The investigation consisted of the following: During the visit LPA interviewed Resident #1 (R1) R1-R11 and
Staff #1 (S1) S1-S7.LPA requested copies of the staff roster, resident roster, and face sheet, physician report, and work order report for air conditioning units.

LPA's investigation revealed the following: regarding the allegation "Staff did not prevent a resident from physically assaulting another resident in care" it is alleged that that a physical altercation occurred between two residents regarding the room temperature.

--Continued LIC 9099-C--

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Tyler Reyes	TELEPHONE: (323) 981-3306
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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-20241003094717

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: LAKEWOOD PARK MANOR	FACILITY NUMBER: 198602950
	VISIT DATE: 10/08/2024

NARRATIVE

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(7) of (7) staff members denied the allegation. Staff indicated that they have not witnessed any altercations between residents nor heard of any residents arguing in regard to room temperature. Staff indicated if they had reason to believe an altercation occurred, they would follow reporting protocol as required and take appropriate actions, including making necessary accommodations for residents. (9) of (11) residents had no knowledge allegation. Residents indicated that they have not experienced or witnessed any altercations between residents nor heard of any residents arguing in regard to room temperature. Resident’s states that the air conditioning unit is respectfully shared in their room with their roommate, and they have no complaints regarding its use. (2) of (11) residents R10 and R11 had altercation resulting in R10 hitting R11 in the face. Investigation revealed that staff had no knowledge of this incident or prior incidents occurring in the facility between R10 and R11. LPA observed residents using the air conditioning unit and there was no visible signs of conflict or discomfort related to its use during the visit.

LPA's investigation revealed the following: regarding the allegation "Facility did not maintain a comfortable temperature for a resident in care." it is alleged that the roommate maintains an unbearable cold temperature in the room. (7) of (7) staff denied the allegation. Staff indicated that if a resident complained of room temperature, they would take appropriate actions, including making necessary accommodations for residents. (9) of (11) residents had no knowledge of the allegation. The temperature is kept at respectable temperature degree in their room. (2) of (11) stated they had prior issues regarding the temperature of the room but the ac is now kept at a respectable temperature degree in their room. LPA observed the ac unit and window in randomly selected resident's room to be in operable condition .

The investigation revealed the following that staff had no knowledge of this incident or prior incidents occurring in the facility between R10 and R11.

--Continued LIC 9099-C--

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Tyler Reyes	TELEPHONE: (323) 981-3306
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20241003094717

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: LAKEWOOD PARK MANOR	FACILITY NUMBER: 198602950
	VISIT DATE: 10/08/2024

NARRATIVE

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Based on the interviews conducted, files reviewed, and observations conducted there was not enough supportive evidence to concur with the reported allegation; 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 Interviewed conducted and a copy of this report was provided to Assistant Manager Cynthia Flores.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Tyler Reyes	TELEPHONE: (323) 981-3306
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC9099 (FAS) - (06/04)

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