374601395-7-25-2022-08-AS-LTEZ-CGRUVJ-20220728155511

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601395
Report Date: 07/25/2022
Date Signed: 07/25/2022 01:38:41 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
06/21/2022 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20220621082003

FACILITY NAME:	PARADISE VALLEY MANOR		FACILITY NUMBER:	374601395
ADMINISTRATOR:	AARON BURRUP		FACILITY TYPE:	741
ADDRESS:	2575 E. EIGHTH STREET		TELEPHONE:	(619) 470-6700
CITY:	NATIONAL CITY	STATE: CA	ZIP CODE:	91950
CAPACITY:	50	CENSUS: 37	DATE:	07/25/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Assisted Living Wellness Director Cecy Salomon		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Licensee did not protect resident from verbal abuse.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit, to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Assisted Living Wellness Director Cecy Salomon.

It was alleged that Resident #1 (R1) was being called a specific racist word by their roommate [Resident #2 (R2)], and that licensee did not respond to protect R1 from said verbal abuse. CCLD’s investigation consisted of an unannounced facility tour/welfare check, review of pertinent facility records, and interview of relevant residents, staff, and outside sources.

The Department’s investigation could not prove that act(s) arising to the level of verbal abuse (and which necessitated licensee intervention) occurred. According to R2, English is not their first language (something LPA observed during their interview). They confessed to once using a racist word during conversation with R1, not fully understanding its meaning. [CONTINUED ON LIC 9099-C, 1 of 2]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022

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-20220621082003

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: PARADISE VALLEY MANOR	FACILITY NUMBER: 374601395
	VISIT DATE: 07/25/2022

NARRATIVE

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[CONTINUED FROM LIC 9099] After seeing R1 become angry, R2 never used the word again. This contrasted with R1’s interview, where they said S2 used the racist word repeatedly, and that its use was distinctly overheard by an outside source, by their conservator, by Staff #1 (S1), and by neighboring Resident #3 (R3). However, the outside source told LPA while they heard second-hand about the allegation from R1, they never observed/overheard such act, and denied bringing it to the attention of facility staff. R1’s conservator, S1, and R3 also denied observing/overhearing any such act, or even knowing about R1’s allegation against R2. According to 2 of 2 additional direct care staff assigned to both R1 and R2’s care: they argue with each other, with R1 usually instigating the squabbles. However, none of these staff witnessed, overheard, or heard about either resident saying anything racist towards the other.

The evidence did not show that licensee failed to respond to R1’s allegation. When LPA asked each resident if they wanted to change rooms to get away from each other: R1 said of R2, “[They] are not a bad [person.] They are nice to me now, after [Manager #1 (M1)] came out.” [When LPA spoke to M1: they denied witnessing, overhearing, or hearing about either resident saying anything racist towards the other and thus never needed to confront either one about that it.] R1 denied to LPA ever requesting a room change from facility staff on account of R2’s conduct (which M1 corroborated). R2 also denied to LPA ever requesting a room change from facility staff, saying of R1, “[They] talk a lot, talking and talking, shares a lot,” but also “I still want to be [their] roommate. [They] are my friend.” M1 confirmed that they approached R2 in the past to inquire if they wanted to change rooms (after seeing R1 instigate arguments with them), but R2 insisted on staying with R1. M1 said in the approximate year that R1 has lived at the facility, they had 4 other roommates before R2. R1 had a habit of shouting out unsolicited comments towards each roommate (something unanimously corroborated by staff, R1’s conservator, and the facility’s written care notes). The first roommate requested a room change to get away from R1, which M1 granted. The second roommate was largely unaware of their surroundings, to include R1. (LPA was unable to interview either one since each had passed away by the time of this complaint). M1 initiated the relocation the third roommate to a different room (this resident told LPA that R1’s behavior annoyed them). M1 initiated the separation of a fourth roommate to a different room away from R1 (this resident also told LPA that R1’s behavior annoyed them). The Department concluded that by the time of this investigation, R1 was finally situated with a roommate (R2) who wanted to cohabit with them, that the sentiment was mutual, and that licensee’s repeated flexibility with room changes supported residents’ personal rights.

[CONTINUED ON LIC 9099-C, 2 of 2]

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 08-AS-20220621082003

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: PARADISE VALLEY MANOR	FACILITY NUMBER: 374601395
	VISIT DATE: 07/25/2022

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	[CONTINUED FROM LIC 9099-C, 1 of 2] Based on records and interviews, a preponderance of evidence does not exist to prove that licensee did not protect R1 from verbal abuse. The allegation is therefore unsubstantiated. An exit interview was conducted with Salomon, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022

LIC9099 (FAS) - (06/04)

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