374602972-1-30-2024-08-AS-LTEZ-CZZVYG-20240131155108

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602972
Report Date: 01/30/2024
Date Signed: 01/30/2024 04:05:32 PM

Unsubstantiated

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
10/10/2023 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20231010130300

FACILITY NAME:	PLAZA VILLAGE SENIOR LIVING		FACILITY NUMBER:	374602972
ADMINISTRATOR:	SHETLER, MARIA		FACILITY TYPE:	740
ADDRESS:	950 L AVE		TELEPHONE:	(619) 474-4844
CITY:	NATIONAL CITY	STATE: CA	ZIP CODE:	91950
CAPACITY:	85	CENSUS: 62	DATE:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Executive Director Maria Shetler		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff did not provide resident with clean linens
Staff did not provide adequate clothing to resident
Staff did not keep facility free of odor

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to deliver complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Maria Shetler.

Throughout the investigation, the Department secured pertinent records and conducted interviews with external and internal sources, including staff and residents.

It was alleged staff did not provide a resident with clean linens. Interviews with internal and external sources did not reveal any concerns regarding lack of lines at the facility. On multiple occasions, the LPA conducted tours of the facility and witnessed the facility had sufficient lines available for the resident in care. Although interviews revealed it was the residents’ responsibility, or residents’ responsible party to provide linens, the facility had an emergency supply readily available.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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-20231010130300

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: 01/30/2024

NARRATIVE

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It was alleged staff did not provide adequate clothing to a resident. Interviews with internal and external sources did not reveal any concerns regarding lack of clothing for the residents in care. Throughout the investigation, the LPA toured several of the residents’ closets and witnessed sufficient clothing for each resident. Additional interviews revealed the resident in question had often declined to receive assistance from staff. Staff had to encourage this resident, and on some occasions, communicated with the resident’s responsible party. The resident’s responsible party had convinced the resident to accept assistance.

It was alleged staff did not keep the facility free of odor. Interviews with internal and external sources did not reveal any concerns regarding the facility not addressing odors at the facility. The facility may experience odors due to assisting residents with incontinent care, but the staff addressed the odors. During several tours to the facility, the LPA did not smell any odors at the facility.

Based on the evidence obtained, the allegations were Unsubstantiated.

An exit interview was conducted with Executive Director Shetler, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058), were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

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