374602972-1-30-2024-08-AS-LTEZ-CZZP9Z-20240131100757

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602972
Report Date: 01/30/2024
Date Signed: 01/30/2024 03:59:00 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
10/13/2023 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20231013145230

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:	04:10 PM

ALLEGATION(S):

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Staff do not encourage resident to participate in activities
Facility did not treat scabies outbreak

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to conduct additional interviews and 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 that staff did not encourage a resident to participate in activities. It was reported to the Department and external source had visited the facility and witnessed a resident in bed. When this source asked if the resident participated in activities, staff said yes, but could specify which activities. Interviews with both internal and external sources revealed it was common for the resident in question to decline to participate in any activities. Interviews also revealed the facility did offer and encouraged the facility residents to participate in different activities throughout the day.

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-20231013145230

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 the facility did not treat a scabies outbreak. It was reported to the Department a source visited the facility, asked staff if the facility had a scabies outbreak, and staff did provide a clear answer if the scabies were treated. Interviews with internal and external sources revealed there had been two residents treated for scabies. Interviews also revealed one of the two residents had refused showers on several occasions, which could have reduced the effectiveness of the prescribed medication. Review of medication lists revealed the residents did have prescribed medication to address the skin condition.

Based on the evidenced obtained throughout the investigation, 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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