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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602972
Report Date: 08/04/2025
Date Signed: 08/05/2025 03:51:32 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
07/30/2025 and conducted by Evaluator Liliana Silveira
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250730153043
FACILITY NAME:PLAZA VILLAGE SENIOR LIVINGFACILITY NUMBER:
374602972
ADMINISTRATOR:SHETLER, MARIAFACILITY TYPE:
740
ADDRESS:950 L AVETELEPHONE:
(619) 474-4844
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:85CENSUS: 63DATE:
08/04/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Executive Director Megan Amy MooreTIME COMPLETED:
06:15 PM
ALLEGATION(S):
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Facility pull chords are in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced visit to conduct a complaint investigation visit and to deliver findings. LPA Silveira introduced themselves, disclosed the purpose of the visit and was granted entry into the facility by Executive Director Megan Amy Moore. Wellness Director Monie Harris joined shortly after.

The Department’s investigation consisted of observations and interviews. On July 30, 2025, it was alleged that the facility pull chords in resident bathrooms are in disrepair. The Department, along with a care staff, the Executive Director and the Wellness Director, tested the following resident bathroom pull chords: 1. The resident bathroom on floor one, which was found to be working. 2. The resident bathrooms in community rooms 4E, 4B, 4B hallway and 3A, which did not transmit the alert to the staff's pager. The Department also conducted interviews and found that four (4) out of five (5) residents interviewed stated that the pull chords in their bathrooms did not work. (CONTINUED ON NEXT PAGE, LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
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 5
Control Number 08-AS-20250730153043
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: PLAZA VILLAGE SENIOR LIVING
FACILITY NUMBER: 374602972
VISIT DATE: 08/04/2025
NARRATIVE
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(CONTINUED FROM PAGE 1, LIC 9099)
Based on interviews and observations, the preponderance of evidence showed that the pull chords in 4 out of 5 bathrooms tested did not transmit signals to the staff pager. The allegation is therefore substantiated. A deficiency is cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D).

A Plan of Correction was jointly developed with the Executive Director. The ED, who represents the new management team who took over on July 9, 2025, immediately purchased a new call button system that will replace the pull chords and will be installed immediately. The ED provided proof during the complaint visit that the system was purchased.

**NOTE: LPA Silveira left the facility for a one (1) hour lunch break and returned to complete the investigation.

An exit interview was conducted with Megan to whom a copy of this report, the LIC 9099 D page and the Licensee/Appeal Rights (LIC9058 01/16) were provided.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20250730153043
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PLAZA VILLAGE SENIOR LIVING
FACILITY NUMBER: 374602972
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/18/2025
Section Cited
CCR
87303(i)(1)(B)
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87303 Maintenance and Operation: “(i) Facilities shall have signal systems which shall meet the following criteria:(1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall:
(B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. This requirement was not met, as evidenced by:
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The Executive Director will order a new alert system for residents to use when needing assistance in all facility bathrooms. Due Date is 08/18/25.
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Based on observations, 4 out of 5 pull chords in resident bathrooms did not transmit a signal/alert to staff pagers. This posed a potential health risk to 63 of 63 residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
07/30/2025 and conducted by Evaluator Liliana Silveira
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250730153043

FACILITY NAME:PLAZA VILLAGE SENIOR LIVINGFACILITY NUMBER:
374602972
ADMINISTRATOR:SHETLER, MARIAFACILITY TYPE:
740
ADDRESS:950 L AVETELEPHONE:
(619) 474-4844
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:85CENSUS: 63DATE:
08/04/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Executive Director Megan Amy MooreTIME COMPLETED:
06:15 PM
ALLEGATION(S):
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Licensee did not facilitate resident council meeting(s).
Facility bathrooms are out of order.
Residents do not have access to drinking water.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced visit to conduct a complaint investigation visit and to deliver findings. LPA Silveira introduced themselves, disclosed the purpose of the visit and was granted entry into the facility by Executive Director Megan Amy Moore. Wellness Director Monie Harris joined shortly after.

The Department’s investigation consisted of observations, interviews and a records review. On July 30, 2025, it was alleged that residents did not have access to drinking water. The facility has four floors and residents live on all four floors. Residents live in a community based setting, where 3-4 resident rooms are attached to living rooms and kitchens. Observations made from a visit conducted by the Department on August 4, 2025 revealed that there was a water dispenser present on the first floor in the dining area, as well as on the fourth floor in the activities room. Interviews with four (4) residents revealed that there were no complaints regarding access to water. (CONTINUED ON NEXT PAGE, LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20250730153043
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: PLAZA VILLAGE SENIOR LIVING
FACILITY NUMBER: 374602972
VISIT DATE: 08/04/2025
NARRATIVE
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(CONTINUED FROM PAGE 1, LIC 9099) During the interviews, residents shared that they have access to water through the water dispensers, through refrigerator filters and through sinks in their kitchens. Some residents stated that they purchase bottled water at stores nearby. An interview with the Executive Director (ED) and the Wellness Director (WD) also revealed that two metal water dispensers were removed from the top floor and new clear, plastic dispensers are in the process of being purchased for sanitary reasons. There was insufficient evidence to support this allegation.

It was also alleged that facility bathrooms are out of order. The Department conducted a tour and tested various bathrooms on all floors and did not observe any bathrooms that were out of order. Interviews with four residents also revealed that there was no issue with bathrooms being out of order. An interview with a staff revealed that no residents have complained about bathrooms being out of order. Finally, an interview with the ED revealed that there was a bathroom on the first floor that had clogged about two weeks ago, but it was fixed. The ED also stated that they had not received any complaints from residents about bathrooms being out of order. There was insufficient evidence to support this allegation.

It was also alleged that the Licensee did not facilitate Resident Council meetings. Specifically, it was alleged that there hasn’t been a Resident Council meeting for a year. An interview with Resident #1 (R1) who has lived at the facility since 2019, revealed that there isn’t a strong interest by residents to participate in resident councils. R1 stated that the previous management used to conduct monthly meetings where residents could share their concerns with management and that no residents would participate. Interviews with four (4) other residents revealed that only one showed interest in a Resident Council. Finally, an interview with the Executive Director revealed that since the facility is under new management, they are working on adding monthly Resident Council meetings to the activities calendar and will post flyers throughout the facility to inform residents about the next meeting. There was insufficient evidence to support this allegation.

Due to a lack of corroborating evidence, the allegations that: the Licensee did not facilitate resident council meeting(s), that the facility bathrooms are out of order and that residents do not have access to drinking water are unsubstantiated. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations occurred, therefore, the allegations are unsubstantiated. This report was discussed with Megan Amy Moore. A copy of this report, along with Licensee/Appeal Rights, (LIC 9058 03/22) were provided. Signature below acknowledges receipt of the documents.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5