198602950-7-2-2021-28-AS-MVAO-C5QTG5-20210809144233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 06/29/2021
Date Signed: 07/02/2021 04:04:08 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
02/24/2021 and conducted by Evaluator LaJean Nicole Spencer

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210224130136

FACILITY NAME:	LAKEWOOD PARK MANOR		FACILITY NUMBER:	198602950
ADMINISTRATOR:	LISA PHAM		FACILITY TYPE:	740
ADDRESS:	12045 LAKEWOOD BLVD		TELEPHONE:	(562) 923-4417
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	160	CENSUS: 110	DATE:	06/29/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Cynthia Flores, assistant administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility not allowing resident's physical therapist into facility.
Facility not providing assistance in meeting necessary medical and dental needs.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Spencer conducted a subsequent visit to conduct interviews and deliver the findings for the allegation listed above. LPA Spencer met with assistant administrator Cynthia Flores and explained the purpose of today's visit.

The investigation consisted of the following: During the initial investigation on 3/4/21, LPA Spencer conducted a physical plant tour and completed telephone interviews with case manager Elizabeth Martinez and resident #1-#3 (R1-R3). The LPA obtained copies of staff roster, resident roster, essential visitors log, policy letter for essential visitors, calendar of scheduled appointments, MAR log for R1-R3, and for a specified resident: contact information for physical therapist, needs and services plan, and MAR Log. During today's visit, LPA Spencer interviewed staff #1-4 (S1-S4), residents #3-10 (R3-R10), and R1's physical therapist (PT). R7 declined to be interviewed so a total of 9 residents were interviewed.
***See LIC9099C for continuation of narrative.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
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-20210224130136

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

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

The investigation revealed the following:

Facility not allowing resident's physical therapist into facility.
It was alleged that the facility denied access to a resident's physical therapist. 8 out of 9 residents interviewed stated that they have not that issue or heard of other residents having that issue. All staff interviewed stated that medical professionals, including physical therapists, are allowed inside the facility and are never denied access. Staff denied having knowledge of any resident having this issue. The PT interviewed stated that their agency has never been denied access to the facility even during COVID-19. A review of the policy letter for essential visitors stated that due to COVID-19, all visits need to be scheduled in advance and take place Monday-Friday between 9 am- 5 p.m. During the facility tour, LPA observed signs that stated that essential visitors and medical professional are allowed in the facility and there was a sign-in log for essential visitors.

Facility not providing assistance in meeting necessary medical and dental needs.
It was alleged that the facility staff are not providing assistance with scheduling necessary medical and dental appointments for residents. 7 out of 9 residents interviewed stated that they have not had that issue or heard of other residents having that issue. All staff interviewed stated that if residents need assistance making appointments, the facility staff will immediately assist them and denied knowledge of any resident that was not given assistance. Staff stated that it is typically the receptionist or med tech staff who will call and make the appointment for the resident if they request it. A review of the Needs and Services care plan checklist shows that residents are given assistance with doctor appointments and transportation services. The calendar of scheduled appointments shows that the facility tracks the date, time, and transportation of appointments for residents.

Based on interviews, observations and records reviewed, the findings indicate that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted with the assistant administrator Cynthia Flores and copy of report was provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
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)

Page: 2 of 2