374602784-6-23-2023-08-AS-SJAB-CT7L64-20230627082807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602784
Report Date: 06/22/2023
Date Signed: 06/23/2023 07:37:48 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
03/16/2021 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20210316103421

FACILITY NAME:	PLEASANT VALLEY RESIDENTIAL CARE		FACILITY NUMBER:	374602784
ADMINISTRATOR:	LEILA FERNANDEZ		FACILITY TYPE:	735
ADDRESS:	4711 CRESTMONT PLACE		TELEPHONE:	(760) 519-1553
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	4	CENSUS: 2	DATE:	06/22/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	LIcensee Fernandez and Administrator Fernandez		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Administrator threatened to evict resident.
Administrator does not allow resident to have private visitations.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings regarding the above listed complaint allegations. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Administrator Fernandez and Administrator Fernanadez.

The Department's investigation consisted of staff and outside source interviews, a resident record review and facility tour.

It was alleged the facility Administor threatened to evict Client 1 (C1). At the time the complaint was filed COVID-19 still had a high prevalence, and facilities were still under strict guidelines. An interview conducted with the facility Administrator (S1) revealed C1 was requesting to go back to work. The interview also revealed C1's Responsible Party (RP) told C1 they could not go back to work and needed to remain at the facility. S1 revealed they never threatened an eviction but advised C1 to listen to their RP. S1 also revealed C1 did not want to communicate with their RP, and C1 felt their RP was too controlling and held C1 back in life.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2023

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-20210316103421

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: PLEASANT VALLEY RESIDENTIAL CARE	FACILITY NUMBER: 374602784
	VISIT DATE: 06/22/2023

NARRATIVE

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An interview with an Outside Source (OS1) corroborated C1 was never threatened with an eviction by a facility staff, rather C1 threatened to leave the facility. OS1 also revealed they had not heard from C1 in approximately 2 years and is unaware of C1's whereabouts. However, the interview with OS1 also revealed prior to the pandemic they would visit C1 consistently and they would take C1 on outings. OS1 also revealed due to COVID-19 there were times visitation was not feasible. OS1 revealed facility staff only implemented no visitations when warranted due to COVID-19.

A resident record review revealed C1 was diagnosed with Mild Intellectual Disability (MID), was allowed to leave the facility unassisted, and was able to conduct their own activities of daily living (ADLs) independently but would require reminders.

Due to lack of corroborating evidence, the finding regarding the above allegations were established to be unsubstantiated. This finding means although the allegations may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

LPA Correia conducted an exit interview with . At the time of the exit interview LIcensee Fernandez was advised a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) will be provided and signature on this report acknowledges receipt of the documents.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

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