374601552-3-14-2024-08-AS-LTEZ-D3QPB5-20240326110946

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601552
Report Date: 03/14/2024
Date Signed: 03/14/2024 05:28:52 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
03/11/2024 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20240311115112

FACILITY NAME:	LILY OF THE VALLEY II		FACILITY NUMBER:	374601552
ADMINISTRATOR:	ELISOL PUNAY		FACILITY TYPE:	740
ADDRESS:	11419 WESTONHILL DRIVE		TELEPHONE:	(858) 271-6849
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	6	CENSUS: 3	DATE:	03/14/2024
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Staff, Editha Daep		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not meet resident's needs
Staff did not provide food of good quality
Staff did not provide basic laundry services

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegations mentioned above with Staff, Editha Daep.

During today's visit, LPA briefly toured the facility, requested records, interviewed staff and residents. It was alleged staff did not meet Resident #1's (R1) needs concerning showering, dressing, and transferring. R1 was admitted to the facility on 02/14/24. The Admission Agreement was signed and outlined R1 required assistance with dressing, toileting, bathing, grooming, mobility task, laundering of personal clothing, and clean bed linens weekly or as often as needed. R1 had an injury and required assistance from staff. Staff interviews revealed R1 refused assistance and R1 stated they could handle it themselves. Therefore, staff only assisted when R1 requested assistance. Resident interviews confirmed staff are assisting them with their activities of daily living. Some resident interviews revealed they don't always want assistance even if it's provided. Further resident interviews revealed R1 complained about everything and R1 was refusing care. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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 2

Control Number 08-AS-20240311115112

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: LILY OF THE VALLEY II	FACILITY NUMBER: 374601552
	VISIT DATE: 03/14/2024

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

It was also alleged, staff did not provide food of good quality. It was reported the facility served ham, which was possibly spoiled, as it didn't look or smell right. Also, tuna sandwiches were served and the tuna appeared bad due to the smell and dark color. LPA did not observe any ham or tuna in the fridge. Staff stated they do not serve spoiled food or of poor quality. Resident interviews revealed the food was not of poor quality and they enjoy the ham.

Lastly, it was alleged staff did not provide basic laundry services. R1's signed Admission Agreement outlined laundering of personal clothing, and clean bed linens weekly or as often as needed. It was reported R1's clothing was not being washed and they had to wear items for three (3) days in a row. According to staff, R1 did not have much clothing but it was washed. Resident interviews revealed their clothing is being washed. LPA observed a sufficient supply of laundry detergent. It was also reported the bed linens were not being changed. Staff stated the R1 was provided with clean sheets upon arrival. Resident interviews confirmed their linens are being changed. Interviews also revealed resident's will refuse the weekly change of linens.

During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report, along with Licensee Rights (LIC 9058 03/22), were left at the facility. Staff, Editha Daep refused to sign.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2