198602950-5-19-2026-28-AS-DSIS-DUQN9Z-20260604101642

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 05/19/2026
Date Signed: 05/19/2026 01:57:40 PM

Substantiated

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
02/22/2026 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260222191617

FACILITY NAME:	LAKEWOOD PARK MANOR		FACILITY NUMBER:	198602950
ADMINISTRATOR:	CYNTHIA FLORES		FACILITY TYPE:	740
ADDRESS:	12045 LAKEWOOD BLVD		TELEPHONE:	(562) 923-4417
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	160	CENSUS: 119	DATE:	05/19/2026
		UNANNOUNCED	TIME BEGAN:	10:48 AM
MET WITH:	Cynthia Flores		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Facility staff did not ensure that facility is free of pests.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Christian Gutierrez conducted a subsequent unannounced complaint visit in response to the above allegations. LPA met with Administrator Cynthia Flores who assisted with today’s visit.

The investigation consisted of the following: During the initial visit conducted on 03/03/2026 visit LPA obtained copies of the following documents: staff roster, resident roster, R1’s physicians report, mattress inventory sheet, and pest control invoice. LPA conducted a tour of random bedrooms on second floor. LPA conducted interviews with residents 1- residents 8 (R1-R8). On today’s visit LPA interviewed Administrator, and staff#1-Staff#6 (S1-S6) and delivered findings.

See LIC 9099

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

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 5

Control Number 28-AS-20260222191617

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: 05/19/2026

NARRATIVE

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In regard to the allegation” Facility staff did not ensure that facility is free of pests.”, It is alleged that R1 had a bed bug infestation due to staff replacing bedframe obtained from storage. During interviews with Administrator and staff four (4) out of seven (7) staff stated that R1’s room was treated for bed bugs. Administrator stated that R1’s headboard and mattress had been replaced but could not recall if it was before or after treatment and if that was the source of bed bugs. During interviews with residents two (2) out of eight (8) stated that they have had bed bugs in their rooms. R1 stated that as soon as headboard was brought in bugs were observed, Administrator was notified of bugs and frame was removed. LPA Gutierrez observed work order from Bug Free Central Inc service report dated 01/28/26, that indicated room BB01 was treated for bed bugs and a mattress inventory log that stated 59 A replaced mattress on 01/25/26 and 59A & B had mattresses replaced on 02/03/26.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted, and a copy of this report and appeal rights were given to Cynthia Flores.

Deficiency is being cited. Exit interview was conducted and a copy of this report, 9099-D and appeals rights was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260222191617

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/19/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/26/2026 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.	1 2 3 4 5 6 7	*Facility provided proof of pest control service report dated 01/28/26 for bed bug treatment. No further action required. Administrator stated to LPA Gutierrez that the facility would inspect stored mattresses and headboards before bringing into facility.
	8 9 10 11 12 13 14	Based on observations, interviews and records reviewed, R1's room was being treated for bed bugs on 01/28/26.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
02/22/2026 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260222191617

FACILITY NAME:	LAKEWOOD PARK MANOR		FACILITY NUMBER:	198602950
ADMINISTRATOR:	CYNTHIA FLORES		FACILITY TYPE:	740
ADDRESS:	12045 LAKEWOOD BLVD		TELEPHONE:	(562) 923-4417
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	160	CENSUS: 119	DATE:	05/19/2026
		UNANNOUNCED	TIME BEGAN:	10:48 AM
MET WITH:	Cynthia Flores		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Facility staff did not safeguard resident's personal belongings.
Resident's room is malodorous.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 28-AS-20260222191617

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: 05/19/2026

NARRATIVE

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In regard to the allegation “Facility staff did not safeguard resident's personal belongings”, it is alleged that facility did not safeguard R1’s property while room was being fumigated and R1’ had no access to clothes or toiletries. During interviews with Administrator and staff seven (7) out of seven (7) stated that when a room is being fumigated or is being worked on a special lock is placed on door to prevent anyone from coming in and taking anything. Administrator stated that the facility has a house supply of hygiene products and clothes can be accessed for resident if asked. During interviews with residents three (3) out of eight (8) residents stated they have had items stolen from rooms, but nothing has been done about it. R1 felt it was a staff member that stole something but did not have proof.

In regard to the allegation “Resident's room is malodorous”, it is alleged that R1’s room smells of urine. During interviews with Administrator and staff seven (7) out of seven (7) stated that the rooms are cleaned daily and residents with incontinence needs have their diapers changed every two hours or as needed. S2 stated that some residents do have urinals next to there beds that can sometimes cause the rooms to smell like urine, but they are not dirty. During interviews with residents seven (7) out of eight (8) residents stated they have there rooms cleaned daily and that staff does a good job at it. R1 stated only time room has odor is when roommate has diaper changed. LPA did a random room check of several bedrooms and did not smell any urine in bedrooms.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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.

An exit interview was conducted, and a copy of this report was given to Cynthia Flores.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

LIC9099 (FAS) - (06/04)

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