198602950-1-17-2026-28-AS-DSIS-DRLNAG-20260224091728

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 01/17/2026
Date Signed: 01/17/2026 10:34:59 AM

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
12/15/2025 and conducted by Evaluator Christian Gutierrez

COMPLAINT CONTROL NUMBER: 28-AS-20251215144131

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:	DATE:	01/17/2026
		UNANNOUNCED	TIME BEGAN:	10:23 AM
MET WITH:	Ariadna Flores Concierge		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Facility staff retaliated against resident for filing a complaint
Facility staff refused resident re-entry resulting in a forced eviction
Facility staff did not ensure inventory of residents personal belongings were maintained
Facility staff did not ensure residents personal items were safely secured
Facility staff does not ensure communication is answered promptly and appropriately

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Ariadna Flores who assisted with today’s visit.

The investigation consisted of the following: During the initial visit conducted on 12/18/2025 LPA obtained copies of the following documents: staff roster, resident roster, R1’s physicians reports, identification information (LIC 601), conservatorship paperwork, preplacement appraisal, admission agreement, and inventory sheet. On 01/12/2025 visit LPA Gutierrez interviewed Administrator, staff 1-staff 6 (S1-S6), and residents 2-residents 10 (R2-R10). On today’s visit LPA Gutierrez delivered findings.

SEE LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2026

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-20251215144131

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: 01/17/2026

NARRATIVE

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In regard to the allegation “Facility staff retaliated against resident for filing a complaint”, it is alleged that R1 was put on a 5150 hold for making a complaint against facility. During interviews with residents nine (9) out of ten (10) residents stated staff has never retaliated or treated them poorly for filing a complaint or doing something staff doesn’t agree with. During interviews with staff six (6) out of six (6) stated they have never retaliated against residents for filing a complaint. Administrator stated that a 5150 hold was placed on R1 because of aggression only after being evaluated by the clinician.

In regard to the allegation “Facility staff refused resident re-entry resulting in a forced eviction”, it is alleged that when R1 was released from hospital R1 was refused entry to facility. During interviews with residents nine (9) out of ten (10) residents stated that they have never been denied re-entry into the facility. During interviews with staff six (6) out of six (6) staff stated R1 was not denied re-entry to facility. Administrator stated that R1 is conserved and conservator made the decision to move R1 to another facility. R1 was never evicted.

In regard to the allegation “Facility staff did not ensure inventory of residents personal belongings were maintained”, it is alleged that R1 had accumulated more inventory and inventory was never taken. During interviews with residents nine (9) out of ten (10) residents stated staff does ask residents to update inventory list when new items are brough in. Residents stated that staff helps them to update list. During interviews with staff six (6) out of six (6) stated they remind residents that inventory list needs to be updated. S3 stated that front desk will stop residents if they see them coming in with something to update their list Staff stated that it is both the responsibility of staff and residents to ensure the list is updated.

In regard to the allegation “Facility staff did not ensure residents personal items were safely secured”, it is alleged that items were missing from R1’s belongings when delivered to new facility. During interviews with residents nine (9) out of ten (10) residents stated that nothing has been missing from their rooms due to staff neglect. During interviews with staff six (6) out of six (6) staff stated they take inventory of every item they pack and take pictures before items are delivered or released to residents. Administrator provided inventory list and pictures of R1’s items that were packed. S2 stated they never throw items away and even still have items from three months ago because a resident has not been able to pick them up.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20251215144131

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: 01/17/2026

NARRATIVE

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In regard to the allegation “Facility staff does not ensure communication is answered promptly and appropriately “, it is alleged that R1 has been contacting facility and staff won’t return phone calls. During interviews with residents eight (8) out of ten (10) residents stated staff does their best to answer them promptly. R2 stated there so busy but they always come to check on me. During interviews with staff six (6) out of six (6) staff stated they have not heard from R1 since he/she has left the facility except when he called to wish the staff a happy new year. Administrator stated R1 has not left any messages.

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 Ariadna Flores.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2026

LIC9099 (FAS) - (06/04)

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