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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426553
Report Date: 08/17/2021
Date Signed: 08/17/2021 01:18:35 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/16/2021 and conducted by Evaluator Stephanie Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210816081433
FACILITY NAME:ELIZABETH MANOR RESIDENTIAL CAREFACILITY NUMBER:
336426553
ADMINISTRATOR:GIZELE KNIGHTFACILITY TYPE:
735
ADDRESS:1884 CENTURY AVENUETELEPHONE:
(951) 215-0952
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:5CENSUS: 4DATE:
08/17/2021
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Nicole Knight-Glass, LicenseeTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Facility staff locked resident out of the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to initiate the investigation into the above allegation. The LPA was greeted by staff, Rebecca Lemus, and informed her of the purpose of her visit. The LPA later met with Nicole Knight-Glass, Licensee.

Regarding the allegation, "Facility staff locked client out of the facility," it was alleged Staff One (S1) locked Client One (C1) outside of the facility on an unknown date. The LPA initiated the investigation on this date; staff/client interviews were conducted, records were reviewed, and copies of pertinent documentation were obtained. Interviews revealed there was an incident that took place in which C1 was outside of the facility while S1 was on shift. It was reported C1 was having a behavioral episode at the time, picked up and threw a rock at the facility window. Staff interviews reported C1 habitually walks in and outside of the facility when experiencing a behavioral episode. One (1) client interview reported C1 threw the rock at the window due to being angry. S1 was interviewed and denied locking the client outside of the facility. One (1) of the five (5) interviews conducted reported C1 was locked outside by S1. Therefore, due to insufficient information, this
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021
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 18-AS-20210816081433
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ELIZABETH MANOR RESIDENTIAL CARE
FACILITY NUMBER: 336426553
VISIT DATE: 08/17/2021
NARRATIVE
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allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No citations have been issued at this time.

An exit interview was conducted, this report was reviewed with Licensee, Knight-Glass and a copy was provided.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2