374602132-9-14-2022-08-AS-DPOL-CJQU7W-20220929152036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602132
Report Date: 09/14/2022
Date Signed: 09/14/2022 09:47:47 AM

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
01/22/2021 and conducted by Evaluator Elizabeth Hamilton

COMPLAINT CONTROL NUMBER: 08-AS-20210122095744

FACILITY NAME:	ANGELES PARADISE II ARF		FACILITY NUMBER:	374602132
ADMINISTRATOR:	MARIA ANGIE ROSE		FACILITY TYPE:	735
ADDRESS:	583 MARIPOSA ST		TELEPHONE:	(619) 656-0062
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91911
CAPACITY:	5	CENSUS: 4	DATE:	09/14/2022
		UNANNOUNCED	TIME BEGAN:	09:21 AM
MET WITH:	Licensee, Maria Rose		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Unlawful Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced complaint investigation visit at the facility. LPA was greeted at the front entrance by Caregiver, Noe Contreras and granted entry after identifying herself. LPA explained the purpose of the visit which was to deliver findings for the above allegation. Licensee, Maria Rose arrived during the visit.

The Department’s investigation consisted of record reviews, interviews with staff and outside sources.

On January 22, 2021, it was alleged that on that date client 1 (C1 see confidential names list LIC-811) was unlawfully evicted from the facility after a hospital stay. C1 was admitted to the hospital and on January 21, 2021 and was ready to be released; it was alleged however, the Licensee would not accept C1 back at the facility due to C1 having a Nephrology Tube inserted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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-20210122095744

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: ANGELES PARADISE II ARF	FACILITY NUMBER: 374602132
	VISIT DATE: 09/14/2022

NARRATIVE

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Interviews with Licensee and outside sources determined that C1 was not ready for discharge from the hospital due to a scheduled surgery which took place on January 27, 2021. Records reviewed confirmed that C1 was then discharged from the hospital on February 10, 2021 to a Skilled Nursing Facility (SNF) for rehabilitation. On February 26, 2021, C1 was discharged back to the care of the Licensee from the SNF and has resided at the facility since that time. On September 14, 2022, LPA observed C1 at the facility. There was insufficient evidence to support the allegation of unlawful eviction.

The Department has investigated the allegation listed above. Based on evidence obtained, including interviews and records reviewed, the above allegation is determined to be unsubstantiated as the Department could not meet the preponderance of the evidence standard. An exit interview was conducted with Licensee, Rose and a copy of this report, LIC 811 and Licensee/Appeals Rights (LIC 9058 01/16) was provided.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC9099 (FAS) - (06/04)

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