198602950-5-27-2025-28-AS-RORN-DH6QL6-20250530121526

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 05/27/2025
Date Signed: 05/27/2025 11:56:18 AM

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
05/22/2025 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250522145901

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: 122	DATE:	05/27/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Assistant Administrator, Cynthia Flores.		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not return resident’s belongings in a timely manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Glenn Trueman conducted the initial complaint investigation for the allegation listed above. LPA arrived unannounced and met with Assistant Administrator, Cynthia Flores. The purpose of the visit was discussed.
During the visit today, LPA obtained copies of the staff roster and resident roster.
Interviews with Assistant Administrator and Staff S1-S3 were conducted.
Interviews were conducted with Residents R2-R7.
File for Resident R1 was reviewed and Resident Inventory List, Physician's Report and ID Face Sheet were submitted.
In regards to the allegation Staff did not return resident’s belongings in a timely manner, based on interviews conducted and information gathered Assistant Administrator stated that no individuals had come 3 times for Resident R1's belongings. When they said he'd be long term at skilled nursing they packed all his belongings to be ready for pick up.
Staff S1- S3 all stated that Resident R1's belongings were packed up and given to a staff from skilled nursing.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2025

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 2

Control Number 28-AS-20250522145901

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: 05/27/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

All stated wallet was not on the Resident Inventory List.
Staff also stated that the Assistant Manager told them to go check for a wallet in Resident R1's room and nothing was located there.
Interviews with Resident's R2- R7 who have resided at the facility ranging between 1 to 5 years.all stated that they had filled out the Resident Inventory List and have never had anything missing.
Also stated they had not heard of anyone elses belongings missing.
All stated that staff treat them well.
LPA observed the Resident Inventory List For Resident R1 which totaled 9 pages and included phone, cassettes and CD player, hats and clothes and was initialed by Resident R1 as being received on 05/09/25.
It should be noted that Resident R1's last day at the facility was 03/04/25.

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 conducted.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2