370804823-5-24-2023-08-AS-LTEZ-CT9LXC-20230629090830

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370804823
Report Date: 05/24/2023
Date Signed: 05/24/2023 01:38:09 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/14/2022 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20220314163959

FACILITY NAME:	ST. PAUL'S VILLA		FACILITY NUMBER:	370804823
ADMINISTRATOR:	ELEANOR DOWNING		FACILITY TYPE:	740
ADDRESS:	2340 FOURTH AVENUE		TELEPHONE:	(619) 232-2996
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92101
CAPACITY:	200	CENSUS: 112	DATE:	05/24/2023
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Executive Director LaTressa Downing		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Staff yelled at resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to conduct follow up and deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Executive Director Eleanor “LaTressa” Downing.

During today's visit, LPA observed residents in care, interviewed staff and residents, and obtained copies of facility records.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that staff yelled at a resident. Interviews and records review revealed that resident 1 (R1) had a diagnosis of mild cognitive impairment, was not confused or disoriented, was able to follow directions and communicate needs, and received assistance with medication administration.
Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20220314163959

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ST. PAUL'S VILLA	FACILITY NUMBER: 370804823
	VISIT DATE: 05/24/2023

NARRATIVE

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Interviews and records review revealed that R1 had a disagreement with Staff 1 (S1) regarding a medication dosage. Interviews revealed that R1 believed that the medication was prescribed on a routine basis. Review of R1’s medication log revealed that those medications were prescribed on an as needed basis. Interviews and records review revealed that S1 was interviewed by the Executive Director and was removed from R1’s care following R1’s complaint to facility staff. Interviews did not support any allegations of S1 treating residents in a rude or disrespectful manner. Interviews did not reveal any concerns regarding the interactions between staff and residents. LPA was unable to interview S1.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Executive Director “LaTressa” Downing, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC9099 (FAS) - (06/04)

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