Lakewood Park Manor

Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Business Office Manager Lauren Cabaron who assisted with today’s visit. The investigation consisted of the following: During the initial visit conducted on 11/04/2025, LPA interviewed Administrator, staff 1- staff 3 (S1-S3) and residents 2 - residents 10 (R2-R10). LPA obtained copies of the following documents: staff roster, resident roster, R1’s physicians reports, identification information (LIC 601), face sheet, preplacement appraisal (LIC 603), appraisal needs and service plan (LIC 625), and physicians order. During today’s visit LPA Gutierrez interviewed staff 4-staff 7 (S4-S7) reviewed random residents’ medication and delivered findings. SEE LIC 9099C UnsubstantiatedRead the full finding— CDSS inspection report, November 10, 2025 · control 28-AS-20251027082759

Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial visit to investigate the above allegations. LPA met with Narine Mertkhanyan/S-1 and discussed the purpose of today’s visit. During this visit, LPA obtained a copy of the resident and staff rosters, interviewed Resident #2 (R-2) through Resident #7 (R-7), interviewed Staff #1 (S-1) through Staff #6 (S-6) and obtained a copy of the activity schedule. LPA attempted to interview Resident #1 (R-1) and was unsuccessful. Resident #8 (R-8) refused to be interviewed. Refer to LIC 9099C for the continuation of this report. UnsubstantiatedRead the full finding— CDSS inspection report, January 13, 2025 · control 28-AS-20250107124635

Licensing Program Analyst (LPA) Angelica Rea conducted a visit in response to the above allegations. On today's visit, LPA met with Assistant Administrator Cynthia Flores, who assisted with the visit. The investigation consisted of the following: Interview(s) with Assistant Administrator, and staff #1 -staff #4, interviews with resident #1- resident #8, review of resident medications, review of facility food supply, and facility menu. Regarding the allegation that staff are not communicating with resident(s). Staff interviewed denied the allegation. Staff stated that staff communicate with residents, and they speak to them in a respectful, polite manner. Residents interviewed were unable to corroborate the allegation. 8 out of 8 residents stated that staff communicate with them in a polite manner. UnsubstantiatedRead the full finding— CDSS inspection report, September 29, 2022 · control 28-AS-20220921115307

Licensing Program Analyst (LPA) Bennette Pena conducted a follow up complaint visit to render findings on the above allegations. LPA met with Assistant Administrator Cynthia Flores and explained the purpose of today's visit. The initial investigation complaint visits were on 11/3/21 and 12/10/21. LPA Nicole Spencer took a tour of the physical plant and interviewed the Residents, Staff and reviewed residents and facility's records. During today's visit, LPA took a partial tour of the facility and exercised strict mitigation measures due to the most recent Coronavirus Disease 2019 (COVID-19) outbreak this facility had. LPA re-interviewed the Assistant Administrator, interviewed two (2) more residents and collected a copy of the staff roster, resident roster, housekeeping/maintenance schedule and housekeeping deep cleaning schedule (Aug-Oct. 2021). LPA also obtained copies of the pest control service invoices, surety bond, and for three (3) specified residents: account balance ledger andRead the full finding— CDSS inspection report, September 14, 2022 · control 28-AS-20211027151500

Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Asst. Administrator (A2: Cynthis Flores); as Administrator (A1: Lisa Pham) was unavailable at the time of this visit. LPA/RA spoke to A2 prior to entering the facility to conduct a risk assessment. A2 informed LPA/RA that the facility has no COVID cases nor do any of the residents or staff members have symptoms. The purpose of today’s visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegation. Initial 10-Day visit was conducted by LPA Nicol Wesley on 12/23/21. LPA/RA Ceniceros interviewed (between 8:30 a.m. - 9:15 a.m.) one (1) staff and one (1) former staff. Resident #1 was not interviewed as the resident moved out on 03/05/20; and, LPA Nicol Wesley conducted pre-investigation. LPA/RA reviewed (between 9:00 a.m. – 9:45 a.m.) pertinent documents: Admissions Agreement (dated 08/09/18), Emergency I.D. andRead the full finding— CDSS inspection report, September 13, 2022 · control 28-AS-20211214111934

***AMENDED REPORT***Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Asst. Administrator (A2: Cynthis Flores); as Administrator (A1: Lisa Pham) was unavailable at the time of this visit. LPA/RA spoke to A2 prior to entering the facility to conduct a risk assessment. A2 informed LPA/RA that the facility has no COVID cases nor do any of the residents or staff members have symptoms. The purpose of today’s visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegations. An initial 10-Day visit was conducted by LPA Nina Galarza on 01/14/22. LPA/RA Ceniceros interviewed (between 10:30 a.m. - 11:30 a.m.) three (3) staff members; however, Resident #1 was not interviewed as the resident moved out of the facility on 12/28/21; however, LPA Nina Galarza conducted the pre-investigation. LPA/RA Ceniceros reviewed (between 12:30 p.m. – 1:30 p.m.) pertinent documents: AdRead the full finding— CDSS inspection report, September 13, 2022 · control 28-AS-20220105161023

Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegations listed above. LPA met with Assistant Administrator, Cynthia Flores and Administrator Lisa Pham and explained the reason for the visit. The investigation consisted of the following: LPA Margaryan conducted interviews with Administrator, Assistant Administrator, Staff 1 to Staff 4 (S1 to S4) and Resident 1 to Resident 5 (R1 to R5). The following documents were requested: staff and residents roster, Staff schedule (with staff names) for the month of August, copies of relevant documents from R#1 file were provided. S1 and R1 were interviewed over the phone. S1 was off and R1 was out of the facility at the time of visit. Continue 9099C UnsubstantiatedRead the full finding— CDSS inspection report, September 1, 2022 · control 28-AS-20220822142735

Licensing Program Analyst (LPA) Nune Margaryan conducted a subsequent complaint visit to complete the investigation and deliver findings for the allegations listed above. LPA met with Assistant Administrator Cynthia Flores and explain the purpose for today’s visit. The initial visit was conducted by LPA Nune Margaryan on 12/28/21. During the initial visit LPA interviewed the Assistant Administrator, Administrator, Staff #1-4 (S1-S4 ), and Residents #1-10 (R1-R10). LPA collected a copies of the staff roster, resident roster, showering schedule and other relevant documents. Continue 9099C UnsubstantiatedRead the full finding— CDSS inspection report, June 18, 2022 · control 28-AS-20211220092042

Licensing Program Analyst (LPA) Lopez conducted a complaint visit to investigate the allegations listed above. LPA met with Assistant Administrator, Cynthia Flores and Administrator Lisa Pham and explained the reason for the visit. The investigation consisted of the following: Interviews were conducted with R1 conservator, 5 staff and 3 residents. Resident #1's (R1's) file was reviewed, and facility was toured. The investigation revealed the following: Allegation: Staff unlawfully evicted a resident while in care. All 5 staff denied that resident was evicted from facility. 3/3 residents could not collaborate the allegations. R1 tested positive for Covid-19 on May 31 and facility staff instructed R1 to follow Covid prevention protocols by wearing a mask. S3 stated that R1 kept leaving her room without a mask and S3 told her to put on a mask and R1 slapped S3 on her thigh in response on 6/01/22 Continue on 9099C UnsubstantiatedRead the full finding— CDSS inspection report, June 14, 2022 · control 28-AS-20220606155118

Licensing Program Analyst (LPA) Vasallo conducted a complaint visit to investigate the allegations listed above. LPA met with Assistant Administrator, Cynthia Flores and explained the reason for the visit. Administrator, Lisa Pham was called and notified of the allegations. The investigation consisted of the following: Interviews were conducted with 4 staff and 3 residents. Resident #1's (R1's) file was reviewed and facility was toured. The investigation revealed the following: Allegation: Facility is not communicating with resident's responsible party. Staff interviewed were well informed on R1's needs and medical appointments. Staff indicated they are in regular contact with R1's family and keep them updated through phone calls and text messages. R1 was interviewed and could not confirm if the allegation was true. There was no evidence to prove this allegation occurred. This allegation is unsubstantiated. Continued on 9099C. UnsubstantiatedRead the full finding— CDSS inspection report, June 13, 2022 · control 28-AS-20220608110027

Licensing Program Analyst (LPA) Cynthia Chan conducted the complaint investigation for the allegation listed above. LPA met with Assistant Administrator, Cynthia Flores and explained the purpose of the visit. Administrator, Lisa Pham, arrived shortly thereafter. The investigation consisted of the following: LPA obtained a copy of the staff and resident roster, food menu for the month, and reviewed medications for 9 residents. LPA also toured the facility, interviewed the Administrator, 6 Staff, and a total of 11 Residents. The investigation revealed the following: Regarding - Facility has not provided resident their requested copy of contract. It is alleged that Resident #1 has been requesting for a copy of the Admission Agreement but has not been provided with one. Administrator Pham stated a resident signs the Admission Agreement upon admission and a copy of the agreement is offered to them. She stated a copy is given to residents even though some may not want it. SubstantiatedRead the full finding— CDSS inspection report, May 17, 2022 · control 28-AS-20220509114229

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Assistant Administrator Cynthia Flores and explained the reason for the visit. The purpose of the visit is to investigate the above allegations. At today's visit Resident's 1-8 were interviewed from 9:30 AM to 11:30 A.M. LPA toured the facility and both elevators were operable and the facility was observed to be in good repair. In regards to Facility is understaffed based on interviews conducted and information gathered residents interviewed stated that there is sufficient staff and they do a good job and help with any needs they may have. Staff interviewed stated there are 4- AM staff, and 3-PM staff and the LIC 500 submitted at visit lists the same staff numbers. In addition the Administrator, Assistant Administrator and Resident Director are also available for AM and PM shifts. Based on interviews, observations, and records reviewed, it is determined that although the allegatioRead the full finding— CDSS inspection report, April 5, 2022 · control 28-AS-20211214101414

Licensing Program Analyst (LPA) Galarza conducted an initial 10-Day complaint visit to investigate the above allegations.The purpose of the visit was discussed with Assistant Administrator Cynthia Flores. Administrator Lisa Pham was explained the purpose of the visit and interviewed telephonically. The investigation consisted of: Staff (S1-S7) and residents (R2 - R10) were interviewed. An interview was attempted with resident (R1). Family (F1) was interviewed. Resident (R1's) file was reviewed. The following documents were obtained: Identification and Emergency Information/Residents Face Sheet, Physician Reports, Appraisals, Individual Service Plan (ISP), Incident report dated 1/27/2022, Admission Agreement, resident roster, and LIC 500 Personnel Report were obtained. See LIC 9099C for report continuation. UnsubstantiatedRead the full finding— CDSS inspection report, February 4, 2022 · control 28-AS-20220128150605

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegation of elevator is in disrepair. LPA met with Cynthia Flores, the Assistant Adminstrator, and explained the reason for the visit. During the visit, LPA obtained the Staff and Resident rosters, elevator repair statement. LPA also toured the facility and interviewed the Administrator, Assistant Administrator, 3 Staff, and 10 Residents. In regards to allegation, elevator is in disrepair. It is determined that a second elevator has been non-operable for several months. The Assistant Administrator stated there are 2 elevators and the second elevator is currently not working. The part has been ordered and waiting for it to arrive. Administrator and Assistant Administrator both indicated they have been following up regularly with the elevator company to achieve repair date. LPA observed 2 elevators side by side on the first floor and a sign indicating "Elevator is out of service" on the elevator toRead the full finding— CDSS inspection report, December 15, 2021 · control 28-AS-20211209101633

Licensing Program Analyst (LPA) Nicole Spencer conducted a subsequent complaint visit for the allegations 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 visit on 10/13/21, LPA conducted a tour of the physical plant including a sample of resident rooms and observed meal service. LPA Spencer interviewed the assistant administrator, staff #1-4 (S1-S4), and residents #1-11 (R1-R11). During the course of the investigation, LPA interviewed staff #5-6 (S5-S6). LPA collected a copy of the staff roster, resident roster, menu, cleaning schedule and housekeeping duties. For R1, LPA collected incident reports, police report, physician's report, and admissions agreement. ***See LIC9099C for continuation of this narrative.*** UnsubstantiatedRead the full finding— CDSS inspection report, December 8, 2021 · control 28-AS-20211006120622

Licensing Program Analysts (LPA) Nicole Spencer and Joseph Hanna conducted a subsequent complaint investigation for the allegations 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 visit on 8/3/21, LPA Spencer conducted interviews with the assistant administrator, staff #1 (S1), and resident #1 (R1). LPA Spencer obtained a copy of the staff roster, resident roster, resident face sheet, physician's report, and physician's orders. During today's visit on 12/6/21, LPA 's interviewed resident #2-11 (R2-R11), staff #2 (S2), R1's physician (P1), and R1's home health agency worker (HH1). Regarding the allegation, "staff refused to provide resident's medical record," it was alleged that the facility refused to provide a resident with their medical records upon request. ***See LIC9099C for continuation of the narrative*** UnsubstantiatedRead the full finding— CDSS inspection report, December 6, 2021 · control 28-AS-20210729115524

Licensing Program Analyst (LPA) Angelica Rea initiated the complaint investigation regarding the allegation listed above. LPA met with Cynthia Flores, the Assistant Administrator, and explained the purpose of the visit. Regarding the allegation that resident #1 has been wrongfully evicted, the investigation consisted of interview with Administrator, Staff #1, Staff #2, and review of Resident #1's file. LPA obtained the following from resident #1's file: copy of admission agreement dated 7/26/19, resident appraisal dated 12/26/20, physician's report and copies of special incident report(s). Per interviews with Administrator, and Staff #1- Staff #2, resident #1 attacked resident #2 on 11/6/21. Resident #1 was placed on a 51/50 hold and was admitted to the hospital for evaluation. Per Reporting Party, resident #1 was evaluated on 11/8/21, and the incident was determined to be "situational", and resident #1 needs to follow up with his psychiatrist for possible medication adjustments. AccorRead the full finding— CDSS inspection report, November 15, 2021 · control 28-AS-20211112101724

***Please note: this LIC9099 report supercedes LIC9099 report dated 7/2/21. Additional interviews were conducted but the findings remain the same.*** Licensing Program Analyst (LPA) Spencer conducted a visit to supercede the report dated 7/2/21 for the allegations listed above. LPA Spencer was met by assistant administrator Cynthia Flores and explained the purpose of today's visit. The investigation consisted of the following: On 4/21/21, LPA Spencer conducted the initial investigation, took a tour of the physical plant, and conducted interviews with assistant administrator Cynthia Flores, staff #1 (S1), and residents #2-5 (R2-R5). On 7/2/21, LPA Spencer interviewed the facility's elevator service repair company (W1), staff #2 (S2), resident #1 (R1) and residents #6-11 (R6-R11). R4-R5 declined to be interviewed so a total of 9 resident interviews were conducted. On today's visit, LPA interviewed staff #3-staff #4 (S3-S4) and a follow-up interview with the assistant administrator. ***SeRead the full finding— CDSS inspection report, October 13, 2021 · control 28-AS-20210416111501

Licensing Program Analyst (LPA) Nicole Spencer conducted a subsequent visit to deliver the findings for the allegations listed above. LPA Spencer met with assistant administrators Cynthia Flores and Elizabeth Martinez and explained the purpose of today's visit. The investigation consisted of the following: On 3/18/21, LPA Spencer conducted the initial visit and a 24-hour health and safety check was completed. During the course of the investigation, LPA interviewed assistant administrator Elizabeth Martinez, resident #1 (R1), staff #1 (S1), wheelchair vendor (W1), case worker (W2). LPA Spencer obtained a copy of the staff roster, resident roster, census of residents sent out to skilled nursing, and medical records for R1. For 3 specified residents, LPA obtained face sheet, physician's report, medication log, and physician's orders. ***See LIC9099C for continuation of this narrative. UnsubstantiatedRead the full finding— CDSS inspection report, August 3, 2021 · control 28-AS-20210317094246