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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 06/29/2021
Date Signed: 06/29/2021 04:48:26 PM



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
11/30/2020 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20201130155722
FACILITY NAME:LAKEWOOD PARK MANORFACILITY NUMBER:
198602950
ADMINISTRATOR:LISA PHAMFACILITY TYPE:
740
ADDRESS:12045 LAKEWOOD BLVDTELEPHONE:
(562) 923-4417
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:160CENSUS: 110DATE:
06/29/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Assistant Administrator Cynthia FloresTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff restrained resident.
Resident's showering needs are not being met.
Staff did not provide adequate food service to resident.
Staff restrict resident(s) from socializing with other residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by S1 and explained the reason for the visit.
The purpose of the visit is a subsequent complaint visit to investigate the above allegations.
Shortly thereafter Assistant Administrator Cynthia Flores arrived.
At today's visit Assistant Administrator Cynthia Flores and S1 was interviewed from 9:45 AM to 10:30 AM.
At 10:30 AM LPA along with Assistant Administrator Cynthia Flores toured the kitchen and observed the food supply.
At 10:50 AM S 2 was interviewed.
Resident's 2-7 were interviewed from 11:00 AM to 12:00 PM.
In regards to the allegation Staff restrained resident, based on interviews conducted and information gathered, residents interviewed said that they have not observed of any resident being restrained.
Staff interviewed stated that Resident 1 had a 5150 hold ordered by the doctor and the paramedics had to put Resident 1 on the gurney. Staff is not allowed to restrain. Resident 1 stated everything is ok and that


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn TruemanTELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
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-20201130155722
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: 06/29/2021
NARRATIVE
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he is now in Long Beach and everything is ok with S 1. Would only repeat that everything is ok with Lakewood Park Manor when asked for more specifics regarding restraint.
Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are Unsubstantiated.

In regards to the allegation Resident's showering needs are not being met, based on interviews conducted and information gathered residents stated that staff are good at assisting with their showering needs and have not heard of any problems.
Resident 1 said that all was ok with this facility and is at a new facility. Would only repeat that everything is ok with Lakewood Park Manor when asked for more specifics regarding showering.
Staff interviewed stated that they have a shower log and showed LPA log where it shows Resident 1 was getting his showers. It was also stated that Resident 1 had refused too.

Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are Unsubstantiated.

In regards to the allegation Staff did not provide adequate food service to resident, based on interviews conducted all residents said the food was adequate and that it was fresh.
Staff interviewed stated that all meals are fresh. Said that Resident 1 had never complained that the food made him not feel well. Stated that during pandemic he would eat all meals sent to his room.
Resident 1 said that all was ok with this facility and is at a new facility. Would only repeat that everything is ok with Lakewood Park Manor when asked for more specifics regarding food.
LPA toured the kitchen and saw a sufficient well balanced supply of perishable and non-perishables.
Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are Unsubstantiated.

In regards to the allegation Staff restrict resident(s) from socializing with other residents, all residents stated that staff do not restrict their socializing. They are free to make friends with whoever they want.
Resident 1 said that all was ok with this facility and is at a new facility. Would only repeat that everything is ok with Lakewood Park Manor when asked for more specifics regarding socializing.
Staff said that other residents would complain that Resident 1 was in their room late at nite so they would have to talk to him about the house rules.
Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are Unsubstantiated.




SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn TruemanTELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
LIC9099 (FAS) - (06/04)
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