370808500-3-27-2024-08-AS-SJAB-D67QK7-20240613121354

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370808500
Report Date: 03/27/2024
Date Signed: 03/27/2024 12:16:31 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
08/13/2023 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20230813113231

FACILITY NAME:	NORTH CORDOBA MANOR		FACILITY NUMBER:	370808500
ADMINISTRATOR:	ESPERANZA TAPIA		FACILITY TYPE:	735
ADDRESS:	4120 NORTH CORDOBA AVENUE		TELEPHONE:	(619) 670-5440
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY:	6	CENSUS: 3	DATE:	03/27/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Esperanza Tapia, Licensee & Tony Tapia, staff		TIME COMPLETED:	09:35 AM

ALLEGATION(S):

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Staff did not allow resident to return to the facility after hospitalization.
Resident is being illegally evicted.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Esperanza Tapia, Licensee to discuss the purpose of the visit. Tony Tapia, Administrator arrived during the visit.

LPA conducted the initial investigation visit on August 22, 2023, and was able to interview clients, facility staff, and outside sources. LPA also reviewed records and conducted a physical inspection of the facility. It was alleged that staff did not allow resident to return to the facility after hospitalization. Interviews revealed Client 1(C1) left the facility and did not return on their own. Per C1 Physician’s Report, dated 07/28/2023 it revealed that C1 is able to leave the facility unassisted. When the client returned to the facility, the client was not denied entrance into the facility. Interviews revealed the administrator spoke to C1's case manager at the hospital of C1 not being medication complaint and was worried that C1 may have needed a higher level of care but when the client was released the client came to the facility. Interviews also revealed C1 left again to a doctors appointment and C1 ended up being hospitalized. C1 did not return to the facility after this last hospitalization.There were no witness statements that stated the client was not allowed to return to the facility after their hospitalization.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

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-20230813113231

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: NORTH CORDOBA MANOR	FACILITY NUMBER: 370808500
	VISIT DATE: 03/27/2024

NARRATIVE

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It was also alleged that resident is being illegally evicted. Interviews revealed the staff was going to give the client a 30 day eviction for not following house rules and not taking their medications but rescinded the 30 day notice. Interviews revealed the client went AWOL and then returned. During the time that C1 was away from the facility, interviews revealed that the administrator did not state C1 could not return. Interviews also revealed that when the client was discharged from the hospital they returned to the facility without any issues. Interviews revealed they spoke with C1 regarding being medication compliant and C1 agreed to not break the house rules and that they will take their medications. There were no witness statements supporting the resident was being illegally evicted.

The investigation did not produce supporting evidence or supporting witness statements to substantiate staff did not allow resident to return to the facility after hospitalization and
resident is being illegally evicted. Based on the evidence obtained from interviews, and record review, the complaint allegation is unsubstantiated.

An exit interview was conducted with Tony Tapia, staff and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

LIC9099 (FAS) - (06/04)

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