374601395-1-4-2023-08-AS-JRAE-CNNSR7-20230202130552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601395
Report Date: 01/04/2023
Date Signed: 01/04/2023 01:03:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
10/17/2022 and conducted by Evaluator Renita Hall

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20221017115405

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: 40	DATE:	01/04/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Landon Burrup, Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff physically abused resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Renita Hall and Interim Assistant Program Administrator, Icela Estrada conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA and IAPA were greeted by Director, Landon Burrup, identified themselves, and were allowed into the facility.

During today's visit, LPA and IAPA conducted a staff interview. The Department’s investigation consisted of interviews with staff, residents, outside source, the Ombudsman and review of records. It was alleged that staff #1 (S1) physically abused resident 1 (R1) by slamming R1's feet to the ground while dressing. A review of records revealed that R1 has Mild Cognitive Impairment (MCI). LPA spoke with outside sources and the Ombudsman, and interviews revealed R1 habitually calls 9-1-1 and other outside sources regularly and often does not remember why R1 called. Both sources stated having no concerns with the level of care provided by the facility and have not received complaints regarding above allegation from R1.

See continuation form LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

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-20221017115405

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PARADISE VALLEY MANOR	FACILITY NUMBER: 374601395
	VISIT DATE: 01/04/2023

NARRATIVE

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Interviews with multiple staff revealed no concerns regarding the care provided by S1 or other caregivers and have never witnessed any abuse. Staff #1 denied the allegation or having issues with residents in care, but described having one resident (R1) that is verbally abusive and combative. When R1 is in a "bad mood", S1 requests to be assigned to another resident to allow R1 to de-escalate. In S1's opinion, S1 gets along with R1 and R1 often requests S1 as their caregiver. During interview, R1 described S1 as being "rough" when changing R1's socks, but stated R1 means "well". R1 did not describe any staff member as physically abusive. Interview with the lead Med-Tech revealed no issues with staff physically abusing residents or being rough with residents. Assistant Wellness Director, Cecilia Salomon confirmed that they have not reprimanded or given any written-warning to caregivers involving care.

Based on LPA's observations and interviews which were conducted and record reviews, the preponderance of evidence standard has NOT been met, therefore the above allegation is found to be UNSUBSTANTIATED.

An exit interview was conducted with Med Tech Frances Paragas. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Med Tech and her signature on this report confirms receipt of the Licensee Rights.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

LIC9099 (FAS) - (06/04)

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