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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 371881361
Report Date: 06/20/2023
Date Signed: 06/20/2023 04:11:54 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2023 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20230426172326
FACILITY NAME:QUIET HILLS LIVINGFACILITY NUMBER:
371881361
ADMINISTRATOR:BLAKE, MARY ANNFACILITY TYPE:
740
ADDRESS:884 GRETNA GREEN WAYTELEPHONE:
(760) 270-2075
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 6DATE:
06/20/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cherry Cook, Facility OperatorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility did not notify resident's representative of a change in ownership.
INVESTIGATION FINDINGS:
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On 06/20/2023, Licensing Program Analysts (LPAs), Chinwe Nwogene and Venus Mixson conducted an unannounced visit to conclude the complaint investigation into the allegation listed above. LPA met with facility operator, Cherry Cook who was informed of the purpose of the visit. During the investigation, staff, residents and residents’ responsible parties were interviewed.
Regarding the allegation “Facility did not notify resident's representative of a change in ownership”, LPA interviewed Licensee who acknowledged the business was sold in March 2023 to the new facility operator Cherry Cook without notifying the department. LPA interviewed the Facility Operator who acknowledged bought the business and took over the business effective 3/1/2023.
Based on LPA’s interview the preponderance of evidence standard has been met. Therefore, the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division & Chapter number 6) are being cited on the attached LIC 9099D). An exit interview was conducted, and a copy of this report was reviewed with and provided to Cherry Cook.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2023 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20230426172326

FACILITY NAME:QUIET HILLS LIVINGFACILITY NUMBER:
371881361
ADMINISTRATOR:BLAKE, MARY ANNFACILITY TYPE:
740
ADDRESS:884 GRETNA GREEN WAYTELEPHONE:
(760) 270-2075
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 6DATE:
06/20/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cherry Cook, Facility OperatorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility issued an eviction notice to residents and did not inform licensing.
INVESTIGATION FINDINGS:
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On 06/20/2023, Licensing Program Analysts (LPAs), Chinwe Nwogene and Venus Mixson conducted an unannounced visit to conclude the complaint investigation into the allegation listed above. LPAs met with facility operator, Cherry Cook who was informed of the purpose of the visit. During the investigation, staff, residents and residents’ responsible parties were interviewed.
Regarding the allegation “Facility issued an eviction notice to residents and did not inform licensing”, LPA interviewed Licensee who denied issuing an eviction notice to residents. LPA interviewed Residents and resident’s responsible parties who denied receiving eviction notice.
Based on interviews with staff, and residents there is not enough evidence to support the above allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Cherry Cook.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20230426172326
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: QUIET HILLS LIVING
FACILITY NUMBER: 371881361
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2023
Section Cited
CCR
87109(b)
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Transferability of License
The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least thirty (30) days prior to the transfer of the property or business.
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Licensee no longer has control of the facility.
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This requirement is not met based as evidence by interview. The Licensee did not notify resident's representative of a change in ownership which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3