374602001-3-27-2024-08-AS-SJAB-D42LET-20240405084201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602001
Report Date: 03/27/2024
Date Signed: 03/27/2024 09:18:05 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/02/2020 and conducted by Evaluator Alyssa Ramirez

COMPLAINT CONTROL NUMBER: 08-AS-20201002101306

FACILITY NAME:	SILVER TREE VILLA		FACILITY NUMBER:	374602001
ADMINISTRATOR:	MOHAMMAD ARABSHAHI		FACILITY TYPE:	740
ADDRESS:	1592 SILVER TREE LN		TELEPHONE:	(760) 739-8393
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92026
CAPACITY:	6	CENSUS: 4	DATE:	03/27/2024
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Staff Leila Ardlan		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Facility did not safeguard resident’s medication
Facility staff did not treat resident with dignity
Facility staff threatened resident
Staff mismanaged resident’s mail
Licensee did not arrange for medical care for resident
Licensee did not maintain a comfortable temperature for resident(s)
Licensee did not provide resident with 60-day notice prior to rent increase

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced visit to deliver findings in the above complaint allegations. LPA identified herself and discussed the purpose of the visit with Staff Leila Ardlan.

On October 2, 2020, Community Care Licensing (CCL) received a complaint alleging facility staff did not safeguard resident’s medication, facility staff did not treat resident with dignity, facility staff threatened resident, staff mismanaged resident’s mail, licensee did not arrange for medical care for resident, licensee did not maintain a comfortable temperature for residents and licensee did not provide resident with 60 day notice prior to rent increase.

[Continued on 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alyssa Ramirez	TELEPHONE: (619) 385-7506
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

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-20201002101306

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: SILVER TREE VILLA	FACILITY NUMBER: 374602001
	VISIT DATE: 03/27/2024

NARRATIVE

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[Continued from 9099]

During investigation, LPA Ramirez attempted to collect records (no records were available), conducted a facility inspection and conducted interviews or staff, residents and outside sources.

It was alleged that facility staff did not safeguard resident’s medication. LPA Ramirez observed medication in the facility to be kept in a locked cabinet. Outside Source (OA) reported no concerns for medication not being safeguarded.

It was alleged that facility staff did not treat resident with dignity and staff threatened resident. Residents reported no concerns at the facility. OA reported no concerns.

It was alleged that staff mismanaged resident’s mail, Administrator denied that there have been any issues with resident’s mail. OA reported no concerns.

It was alleged that licensee did not arrange for medical care for resident, Administrator reported that the facility does arrange for medical care of residents and said there is no concern for residents lacking medical care. Residents reported no concerns. OA reported no concerns.

It was alleged that the licensee did not maintain a comfortable temperature for residents, when LPA visited the facility internal temperature of the facility met requirement. OA reported no concerns.

It was alleged that licensee did not provide resident with 60 day notice prior to rent increase, Administrator denied any concerns for allegation. No concerns were reported by residents. OA reported that they have been properly notified when rent has increased and reported no concerns.

Based on LPA's interviews, and lack of corroborating information there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Staff Leila Ardlan to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alyssa Ramirez	TELEPHONE: (619) 385-7506
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

LIC9099 (FAS) - (06/04)

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