198320326-11-1-2024-11-AS-JHAD-DAS2NT-20241106163316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320326
Report Date: 11/01/2024
Date Signed: 11/01/2024 08:09:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/27/2024 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240927164107

FACILITY NAME:	MANNY'S CARE FACILITY		FACILITY NUMBER:	198320326
ADMINISTRATOR:	NAHUM, MANACHA		FACILITY TYPE:	740
ADDRESS:	1782 S SHERBOURNE DRIVE		TELEPHONE:	(310) 309-0405
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	6	CENSUS: 6	DATE:	11/01/2024
		UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Alfian Fnu		TIME COMPLETED:	03:37 PM

ALLEGATION(S):

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Staff member sexually abused resident in care.
Staff do not ensure that resident's hygiene needs are being met while in care.
Staff do not ensure that resident receives medical attention as necessary while in care.

INVESTIGATION FINDINGS:

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On 11/01/24, the Department conducted a subsequent unannounced complaint visit at this facility. The Community Care Licensing (CCL) associate was greeted by Caregiver Staff #2 (S2: Alfian Fnu). CCL associate explained the purpose of this visit is to investigate the allegation mentioned above.

The investigation consisted of the following: A health and safety inspection 10/01/24 and 11/01/24. A review of Resigister of Facility Residents LIC 9020 (dated: 05/09/24), Personnel Report LIC 500 (dated: 03/11/24), Admissions Agreement and Contract (dated: 08/22/23), Physicians Report LIC 602A (dated: 08/17/23), Appraisal/Needs and Services Plan LIC 625 (date: 07/01/24), Medication Administration Record (MAR) (dated: 09/01/24-09/30/24), and CDSS/CCL Investigation Assignment Report (dated: 10/21/24).

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

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 5

Control Number 11-AS-20240927164107

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: MANNY'S CARE FACILITY	FACILITY NUMBER: 198320326
	VISIT DATE: 11/01/2024

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff member sexually abused resident in care.

The nature of this complaint alleged a facility staff sexually assaulted resident #1 (R1). It is reported that a staff had inappropriately handled (R1) during a diaper change activity. There was no further detail information given on this matter.

On 10/18/24, at 10:20 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed resident #1 (R1). (R1) was not able to describe how (R1) was sexually assaulted by staff. (R1) claimed to not know if the staff member is still employed. (R1) reported that the male staff has attempted to hurt (R1) several times and that the male staff is from a “cosmic space”. (R1) was not able to explain how (R1’s) medical needs were neglected. (R1) appeared to have a desultory conversation and made inconsistent statements throughout the interview.

On 10/18/24, at 02:15 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (R1’s) directive and trustee witness #1 (W1). According to (W1), (W1) did not believe (R1) was touched inappropriately at the facility and did not have any concerns. (W1) stated that (R1’s) behavior has changed due to possible medication but described (R1) has always been unhappy. (W1) described (R1) as chronic complainer who tends to be satisfied rarely and will almost always find something wrong.

On 11/01/24, between 10:11 am – 10:50 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (4) out of (5) residents #2-#5 (R2-R5) who were unable to corroborate this accusation. (R2-R5) expressed that facility provided a comfortable and safe environment for residents in care. (R2-R5) have not observed or witness any type of abuse or assault on any individuals. (R1) claimed to have been assaulted by a male staff but refused to be provided further details on the matter. (R1) declined to answer the question if the staff treated her with kindness and respect. (R1) was uncertain if she is provided with a comfortable or safe environment. (R1) did claim to have no concerns for (R1’s) health or safety. (R1) gave inconsistent statements throughout the interview. (R2) claimed to share a room with (R1), reported no such inappropriate activity ever happened. (R2) claimed to have been a witness when the male staff member assisted (R1) during diaper changes and two female caregiver staff were also present. (R2) claimed to have never observed a male staff caregiver alone with (R1) and that female staff caregivers are always present to assist with (R1’s) incontinent needs.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 11-AS-20240927164107

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: MANNY'S CARE FACILITY	FACILITY NUMBER: 198320326
	VISIT DATE: 11/01/2024

NARRATIVE

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On 11/01/24, between 10:51 am – 11:57 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (4) out of (4) staff who refuted this accusation. (S1-S4) reported this accusation is false and that no such incident ever occurred. (S3-S4) are primary caregivers to (R1) explained to have been present that one time to assist with (R1’s) diaper change. (S3-S4) both provided consistent statements on accounts of what happened on that one occurrence during a diaper change with (R1) and the male caregiver present. (S3-S4) explained that the male staff only assisted to propped (R1) by supporting (R1’s) backside – there was no handling below the waist by the male staff during the incontinent activity. (S1-S4) confirmed that only female staffs assist female residents with personal and hygiene needs. (S1-S4) stated that male staff are assigned solely to assist with male residents. Based on the gathered information, there is no evidence to support the allegation mentioned above.

Allegation #2: Staff do not ensure that resident's hygiene needs are being met while in care.

The details of this complaint alleged the facility staff are not able to meet resident #1 (R1’s) hygiene needs while in care. It is reported that (R1) has not been showered in over a year and has not been give pain medication as prescribed. There was no further detail information given on this matter.

On 11/01/24, between 10:11 am – 10:50 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (5) out of (5) residents #5-#5 (R1-R5) who were unable to support this accusation. (R1-R5) reported the facility staff are responsive when it came to assistance and that hygiene services provided are adequate. (R1) denied to have issues or concerns with (R1’s) hygiene care. (R1) was complimentary of staff and claimed the hygiene services provided were satisfactory.

On 11/01/24, between 10:51 am – 11:57 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (4) out of (4) staff who contested this accusation. (S1-S4) reported all the residents including (R1) are provided 24/7 personal and hygiene care services. (S1-S4) disputed the claim of (R1) not being showered for over a year nor had any assistance with prescribed medications. (S1-S4) reported that (R1) is on a routine schedule twice a day for sponge bath and medication management. Based on the gathered information, there is no evidence to support the allegation mentioned above.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20240927164107

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: MANNY'S CARE FACILITY	FACILITY NUMBER: 198320326
	VISIT DATE: 11/01/2024

NARRATIVE

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Allegation #3: Staff do not ensure that resident receives medical attention as necessary while in care.

The details of this complaint alleged the facility staff do not ensure resident #1 (R1) receives the necessary medical attention while in care. It is reported that (R1) would have to call emergency medical services and that care staff will not call paramedics for (R1) when requested. There was no further detail information given on this matter.

On 11/01/24, between 10:11 am – 10:50 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (4) out of (5) residents #2-#5 (R2-R5) who were not able to corroborate this claim. (R2-R5) reported the facility staff are responsive when it came to resident’s requiring medical attention and it is acted timely. (R1) claimed that the staff did not want to call emergency medical services (EMS) when (R1) required medical attention. (R1) did not want to elaborate on the nature of the matter but stated that (R1) had to do calls each time for (EMS) for assistance.

On 11/01/24, between 10:51 am – 11:57 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (4) out of (4) staff who claimed this accusation is false. (S1-S4) has a history of making direct calls on (R1) personal phone to (EMS) or 911 Paramedics. (S1-S2) claimed that (R1) obligates the staff to dispatched for (EMS) or Paramedics when (R1) needs pain medication. (R1) is not experiencing a life-threatening condition such as: breathing problems, chest pain, bleeding, fainting, allergic reaction, injuries, or stroke. (S2) stated that it’s been advised to (R1), that (EMS) or Paramedics are only dispatched for life-threating conditions and if it has to do with (R1’s) medication, (R1) will need to be evaluate by (R1’s) physicians who will prescribe the medication. (S2) reported (R1) is currently on (19) prescribed medications and (2) out of the (19) is for pain. Based on the gathered information, there is no evidence to support the allegation mentioned above.

(CDSS/CCL) associate was not able to obtain statements from resident #6 (R6) as the resident was not available for an interview.

As a result of the Department reviewing (R1’s) Admissions Agreement and Contract (dated: 08/22/23), Physicians Report LIC 602A (dated: 08/17/23), Appraisal/Needs and Service Plan LIC 625 (date: 07/01/24), and Medication Administration Record (MAR) (dated: 09/1/24-09/30/24), revealed (R1) requires assistance with personal activities of daily living, mental condition consists of depression is treated with medications that presents side effects such as dizziness, agitation, anxiety, nervousness, and hallucinations (ref: NIH).

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20240927164107

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: MANNY'S CARE FACILITY	FACILITY NUMBER: 198320326
	VISIT DATE: 11/01/2024

NARRATIVE

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Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegations mentioned in this complaint. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview is conducted with caregiver Alfian Fnu, and a copy of the report is provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

LIC9099 (FAS) - (06/04)

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