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Inspection visit

Complaint

KINGSLEY MANORLicense 197608482
Clean visit · 0 citations

Inspector’s narrative

What the inspector wrote

Regarding allegation: Staff are threatening resident. It is alleged that the facility is threatening resident 1 (R1) with eviction if R1 does not pay the full amount owed for unpaid monthly fees and additional charges to prevent R1 from eloping. It is alleged that the responsible family member was not present to sign off for additional fee and family member did not agree with R1 needing additional services. The investigation reveals the following: After an incident where R1 eloped from the facility on 09/01/2024, the facility reassessed R1. On 09/01/2024, the facility identified R1’s risk of eloping which resulted in staff providing additional service to prevent R1 from eloping from the facility. Due to change of condition, R1 agreed to wear the monitor bracelet and signed the rate increases form with the effective date of 09/01/2024. The facility added services to R1, which consisted of frequent wellness check and monitoring bracelet to alert staff when R1 is attempting to exit the facility. The facility informed R1’s family member on 09/03/2024 via email of fee increase. Based on initial physician’s report dated 08/21/2024, R1’s assessment was reported to be able to follow instructions, able to communicate needs, and able to manage own cash resources. The physician’s report identifies R1 as self-responsible. In addition, LPA’s facility’s invoice review for the period of 08/29/2024 through 08/01/2025 reveals that R1’s last payment for basic service was made on 04/07/2025, which did not pay the outstanding balance in full. Interview with residents reveal that ten (10) out of ten (10) residents denied the allegation. Seven (7) out of seven (7) staff denied the allegation. Based upon the investigation, client and staff interviews, document review, and LPA observations, the facility’s notice to collect on past due account and warning R1 or family member that evection process may be started is not a threat. Report continues on page LIC-809C Regarding allegation: Staff had resident sign a document without resident's authorized representative present It is alleged that the facility did not ensure that an authorized representative was present when R1 signed off the notice for additional services that were added to the monthly basic service fees. It is alleged that R1 cannot speak or read English. The investigation reveals the following: Based on initial physician’s report dated 08/21/2024, R1’s assessment was reported to be able to follow instructions, able to communicate needs, and able to manage own cash resources. The physician’s report identifies R1 as self-responsible. Based on initial Health and Wellness Review dated 08/16/2024, the facility assessed R1’s speech communication status as able to “speak Korean English is second language.” Interviews with staff reveal that seven (7) out of seven (7) staff denied the allegation. Staff denied knowing any staff preventing residents from consulting a third party before signing a facility document. Interviews with six (6) out of seven (7) staff reveal that interaction between staff and R1 were in English, although R1 English skills are limited, R1 was able to communicate his needs. Interviews with residents reveal that ten (10) out of ten (10) residents feel that they are free to consult with any family or senior assistance center for help in the event that residents do not understand a document. All residents denied the allegation above. Residents stated that they have not felt compelled to sign a document without reading it before or getting assistance if they don’t understand the document. LPA’s document review revealed that based on initial physician’s report dated 08/21/2024, R1’s assessment was reported to be able to follow instructions, able to communicate needs, and able to manage own cash resources. The physician’s report identifies R1 as self-responsible. Based upon the investigation, client and staff interviews, document review, and LPA observations, R1 is self-responsible and able to sign documents. The residents are free to consult family before signing any document as stated by residents’ interview. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated . Exit interview was held with Director of Health Services Milca Osorio. A copy of the report was provided.

Citations

1 citation recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87411(a)Type B

    Facility personnel sufficiency and competence

    87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.This requirement is not met as evidenced by: Based on observation, interview, record review, the licensee did not comply with the section cited above in R1 was able to leave facility unassisted even though R1's physician's report stated that R1 was not to be allowed to go out of the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.

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FAQ · About this visit

Common questions about this visit

What happened during the October 7, 2025 inspection of KINGSLEY MANOR?

This was a complaint inspection of KINGSLEY MANOR on October 7, 2025. The inspection found no deficiencies and no citations were issued.

Were any citations issued to KINGSLEY MANOR on October 7, 2025?

No citations were issued during this inspection. The facility was found to be in compliance with all applicable regulations.

What type of inspection was this?

This was a complaint inspection. Complaint inspections are triggered when someone reports a concern about the facility to CCLD.

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