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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426553
Report Date: 10/07/2021
Date Signed: 10/07/2021 12:04:32 PM

Substantiated


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
08/13/2021 and conducted by Evaluator Stephanie Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210813152204

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:
10/07/2021
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Nicole Knight-Glass, AdministratorTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff speak inappropriately towards a client while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to deliver the findings of the investigation into the above allegations. The LPA met with Bre'Ahna Taylor, Assistant Administrator, and informed her of the purpose of the visit. The LPA later met with Administrator, Nicole Knight-Glass.

Regarding the allegation, "Staff speak inappropriately towards a client while in care," it was alleged Staff Two (S2) told Client One (C1) to shut up. The LPA initiated the investigation into the allegation on August 17, 2021; staff/client interviews were conducted, records reviewed, and copies of pertinent information obtained. C1 and S2 were interviewed and denied the allegation. Staff interviews reported no knowledge of C1 being told to shut up by S2 or other staff members. However, three (3) interviews did report observations of S1, S2 and Staff Three (S3) telling C1 to stop lying about alleged incidences and/or that they are a liar. Interviews also reported S1 has been observed teasing Client Two (C2), on different occasions, regarding their appearance and manor of dressing. C2 was interviewed and denied being teased by staff on their appearance and/or manor of
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20210813152204
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2021
Section Cited
CCR
80072(a)(1)
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PERSONAL RIGHTS: Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by: Based on interviews,
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The Administrator agreed to provide proof training to the Department by POC due date.
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the licensee did not ensure C1 or C2 were accorded dignity. Interviews reported S1, S2 & S3 told C1 to stop lying about alleged incidences and/or that they are a liar. Interviews also reported S1 has been observed to tease C2, on different occasions, regarding their appearance & manor of dressing.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20210813152204
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: 10/07/2021
NARRATIVE
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dressing. This allegation is deemed SUBSTANTIATED. A citation will be issued. A finding that the complaint is substantiated means the allegations are valid because the preponderance of the evidence standard has been met.

An exit interview was conducted with Knight; this report was reviewed, and a copy provided, along with LIC 811 and Appeal Rights.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4