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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603633
Report Date: 08/08/2024
Date Signed: 08/08/2024 11:16:40 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
08/01/2024 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240801114621
FACILITY NAME:ALONDRA GUEST MANOR INCFACILITY NUMBER:
198603633
ADMINISTRATOR:KAYA, IWONAFACILITY TYPE:
740
ADDRESS:15203 ALONDRA BLVDTELEPHONE:
(714) 228-1098
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY:6CENSUS: 5DATE:
08/08/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Sandy Lim/S-1 and Iwona KayaTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff do not keep the facility clean and sanitary.
Staff did not ensure resident's hygiene needs were met.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial visit to investigate the above allegations. LPA met with Sandy Lim/S-1 and discussed the purpose of today’s visit. Ywona Kaya (Facility Administrator) arrived at approximately 9:30 A.M.

During this visit, LPA obtained a copy of the resident and staff rosters, reviewed files for R-1 through R-5 (R-1 through R-5) and obtained relevant documentation, interviewed Resident #1 (R-1), Resident #3 (R-3), Facility Administrator, Staff #1 (S-1) and Staff #2 (S-2). LPA was unable to interview Resident #2 (R-2) as R-2 was asleep during this visit. LPA was unable to interview Resident #4 (R-4) and Resident #5 (R-5) due to cognitive impairment. LPA also conducted a facility tour.

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
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-20240801114621
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ALONDRA GUEST MANOR INC
FACILITY NUMBER: 198603633
VISIT DATE: 08/08/2024
NARRATIVE
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Allegation: Staff do not keep the facility clean and sanitary It is alleged that the facility is not kept clean or sanitary. Staff interviews revealed that this facility is kept cleaned and sanitary at all times. Interviewed staff indicated that they have not received any complaints in regards to this matter. LPA conducted a facility tour and observed the facility to be clean and sanitary (including tables used by residents during meal times). Resident interviews revealed that this facility is kept clean and sanitary. Interviewed resident indicated they do not have any concerns regarding this matter. Interviews and facility tour do not corroborate this allegation.

Allegation: Staff did not ensure resident's hygiene needs were met. It is alleged that residents are malodorous and observed to be dirty. Staff interviews revealed staff meet resident’s hygiene needs. Interviewed staff indicated that they assist residents with their activities of daily living daily (including bathing). Interviewed staff indicated that they have not received any complaints in regards to this matter. LPA conducted a facility tour and observed the residents to be clean (including their clothing) and did not observed residents to be malodorous. Resident interviews revealed that staff meet their hygiene needs. Interviewed residents indicated they do not have any concerns regarding this matter. Interviews and facility tour do not corroborate this allegation.

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.



Exit interview conducted, appeal rights and a copy of this report was provided to Ywona Kaya.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2