198602950-10-22-2024-28-AS-RORN-DASNVU-20241107094831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 10/22/2024
Date Signed: 10/22/2024 02:08:57 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
10/14/2024 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241014121852

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: 123	DATE:	10/22/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Cynthia Flores		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility staff is mishandling residents money.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit regarding the above allegations. LPA Villalobos met with Administrator Cynthia Flores and explained the reason for the visit.

The investigation consisted of the following: LPA conducted interviews with Staff#1-4 (S1-S4) and Residents #1-8 (R1-R8). LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1's facility file and collected copies of documents pertinent to the complaint investigation. The investigation revealed the following:

In regards to the allegation "Facility staff is mishandling residents money." it is alleged that R1 is being defrauded financially by the facility as they should be receiving more money a month than they are getting after paying rent....

Conituned on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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-20241014121852

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: 10/22/2024

NARRATIVE

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(4) of (4) Staff interviewed denied the allegation. (7) of (8) Residents could not corroborate the allegation. Interviews with staff show that R1 moved into the facility on 12/20/23 after living in a skilled nursing facility (SNF). The SNF was R1's previous payee for their SSI/SSA benefits and it took time for the payee to be switched over to the current facility. This meant that R1 lived in the facility without paying rent from the day they moved in until June 2024 when the facility became the payee and received the SSI/SSA payments from the social security office. Following the 2024 SSI/SSP payment standards, the facility is only able to charge R1 the max amount of $1418.07, while leaving R1 a Personal and Incidental Needs Allowance (PNI) of $177. LPA reviewed R1s ledger on file and observed that $177 was the amount R1 received monthly after rent was paid. Additionally, the ledger showed an owed balance on file as the payments initially received from the social security office did not cover the total amount owed to the facility. There is a payment plan on file dated and signed 7/16/24 between the facility and R1 stating that R1 would pay $89 from their $177 PNI until it is paid off. This explains why R1 received less than $177 a month after July. R1 stated to not remember signing and if they did, they don't believe they were explained the truth. Additionally R1 claimed to be owed $900 a month but was not sure who or where the money should be coming from or why. As of this visit, R1's debt is paid off and it was stated by staff that going forward, R1's monthly PNI would be $177. Based on interviews, file review, and observations; 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 was conducted. Due to printer issues, a copy of this report will be provided via emailed.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

LIC9099 (FAS) - (06/04)

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