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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602972
Report Date: 12/16/2025
Date Signed: 12/16/2025 06:10:40 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
11/14/2025 and conducted by Evaluator Ramon Serrano
COMPLAINT CONTROL NUMBER: 08-AS-20251114134350
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: 52DATE:
12/16/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Megan Amy MooreTIME COMPLETED:
04:49 PM
ALLEGATION(S):
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The facility charged resident for services not being rendered
Facility staff did not accord resident dignity
Facility staff did not accord resident with privacy
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver complaint investigation findings. LPA introduced himself and stated the purpose of the visit with Executive Director Megan Amy Moore.

The Department’s investigation consisted of interviews with staff, residents, outside sources and review of records.

LPA Ramon Serrano conducted a complaint investigation at the facility regarding Resident 1 (R1). The investigation focused on several allegations including, charging for services not rendered, lack of dignity and privacy and improper infection control practices. R1 reported that their Cox cable service was removed and they were charged for a cable box despite the cable not working. They stated they were without cable for several days during baseball season and felt frustrated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
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 7
Control Number 08-AS-20251114134350
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: 12/16/2025
NARRATIVE
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An outside source confirmed the cable service disruption and that the facility did not adequately address the issue. LPA interviewed Staff 2 (S2) who confirmed they were present when the cable was disconnected. S2 further stated that between August and October, at approximately 4 a.m., residents began yelling at them asking why their cable TV was not working. S2 advised the residents that they had no idea what happened and explained that staff were not informed in advance that the cable service was going to be disconnected. S2 estimated that the cable was out for approximately one week before management provided Fire Sticks to residents who were complaining.

While in isolation due to a COVID diagnosis, R1 reported that staff repeatedly asked if they had COVID, which made them uncomfortable and felt like a violation of their privacy. An outside source confirmed that staff inquiries went beyond necessary symptom checks. Staff 1 and Staff 2 stated that residents are tested but not asked directly about their status.

R1 stated that staff frequently entered their room without knocking. An outside source confirmed that staff entered during a private conversation without knocking. LPA interviewed Staff 1 (S1) who stated they always knock and wait for a response, and if no response is given, they ask if the resident is okay. S2 stated that although R1’s door is usually open, they generally knock before entering any resident’s room. However, they noted that new staff may walk into residents’ rooms without knocking or waiting for permission.

LPA interviewed several residents living near R1. All residents denied experiencing issues with cable or internet, dignity or privacy concerns, being charged for services not rendered, unmet care needs, or COVID-related problems.

The Executive Director explained that the cable issues were inherited from previous management. Cox Communications refused to work with the facility due to an outdated account and unpaid balance. The facility switched providers and provided Fire Sticks or HD antennas at no extra cost. Refunds were issued for Cox-related charges. During the COVID outbreak, the facility followed public health guidelines, used PPE, and posted signage. Although R1 left the facility for fresh air during isolation, staff were reminded to respect privacy and documentation was updated.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 08-AS-20251114134350
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: 12/16/2025
NARRATIVE
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Regarding the grab bars, the building is ADA-compliant and Fire Marshal–approved. R1’s concern was addressed after isolation. The facility met with R1 and the Ombudsman to review all concerns. Staff were retrained, and signs were placed on R1’s door instructing staff to knock and wait before entering. R1 signed a form confirming satisfaction with the steps taken.

The Department has investigated the complaint allegations. Based on evidence obtained the following allegations were substantiated: The facility charged resident for services not being rendered, Facility staff did not accord resident dignity and Facility staff did not accord resident with privacy. This finding means that the preponderance of the evidence standard has been met and the allegations were valid. The deficiency is cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and noted on the attached LIC 9099-D.



An exit interview was conducted, a plan of correction was jointly developed, and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to Megan Amy Moore, Executive Director. Signature on this form confirms receipt of the documents.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
11/14/2025 and conducted by Evaluator Ramon Serrano
COMPLAINT CONTROL NUMBER: 08-AS-20251114134350

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: DATE:
12/16/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:TIME COMPLETED:
04:49 PM
ALLEGATION(S):
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3
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Facility staff did not follow their infection control protocols
Facility did not meet the needs of the resident
The facility did not follow their admission agreement
INVESTIGATION FINDINGS:
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3
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver complaint investigation findings. LPA introduced himself and stated the purpose of the visit with Executive Director Megan Amy Moore.

The Department’s investigation consisted of interviews with staff, residents, outside sources and review of records.

LPA Ramon Serrano conducted a complaint investigation at the facility regarding Resident 1 (R1)

While in isolation due to a COVID diagnosis, R1 reported that staff repeatedly asked if they had COVID, which made them uncomfortable and felt like a violation of their privacy. An outside source confirmed that staff inquiries went beyond necessary symptom checks. Staff 1 and Staff 2 stated that residents are tested but not asked directly about their status.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
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 7
Control Number 08-AS-20251114134350
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: 12/16/2025
NARRATIVE
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 R1 reported being denied access to fresh air during their COVID isolation period and felt imprisoned. Staff interviews confirmed that public health protocols required COVID-positive residents to remain in their rooms. There was no evidence that staff denied access for reasons beyond these protocols.

R1 stated that the grab bars in an isolation bathroom were incorrectly positioned and hindered their mobility. An outside source confirmed the grab bars did not support R1’s needs. Staff 2 confirmed that one of bathroom's was too small for a walker and the grab bars were awkwardly placed. LPA confirmed that their were two bathrooms that R1 had access to. The bathroom closest to R1's room was large with properly placed grab bars. R1 had the option to use the a large bathroom that both fit R1's walker and proper grab bars.

LPA reviewed R1’s admission agreement dated 12/4/19. The agreement stated that the facility would provide core services included in the monthly fees unless otherwise indicated. These services included utilities, and the facility would furnish the apartment with telephone and television outlets. The agreement also specified that residents would be responsible for premium cable or satellite television fees, which would be billed directly from the provider. Records review revealed that a refund of $60.00 was issued on 11/12/25 to R1 from the facility for cable services not rendered. LPA also reviewed email communication dated 7/17/25 from the facility licensee to Cox Cable, showing the facility was attempting to start service under new management following a recent change. The Executive Director explained that the cable issues were inherited from previous management. Cox Communications refused to work with the facility due to an outdated account and unpaid balance. The facility switched providers and provided Fire Sticks or HD antennas at no extra cost.



Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are unsubstantiated.

An exit interview was conducted with Megan Amy Moore. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Megan Amy Moore whose signature below verifies receipt of these rights.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Citations on this Visit Report are Under Appeal!

Control Number 08-AS-20251114134350
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: 12/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
01/15/2026
Section Cited
CCR
87507(f)
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(f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met as evidenced by:
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Per Licensee R1 was refunded their cable fees before the complaint was submitted. Per Licensee the new facility management no longer directly handles the cable services, the providers work directly with residents.
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Based on interviews and records review R1's cable service which was include in R1's monthly rate was disconnected and R1 was charged for services not rendered.This posed a potential personal rights risk to 1 in 1 in care.
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Under Appeal
Type B
01/15/2026
Section Cited
CCR
87464
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(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:
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Per Licensee the facility conducted a training regarding "HIPPA" in October 2025. Licensee stated that they will also conduct another inservice training regarding resident dignity. Licensee will submit training log to LPA by POC due date
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Based on interviews R1 was repeatedly asked by staff about their covid status. This posed a potential personal rights risk to 1 in 1 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: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Citations on this Visit Report are Under Appeal!

Control Number 08-AS-20251114134350
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: 12/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
01/15/2026
Section Cited
CCR
87468.2(a)(1)
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... Personal Rights of Residents... residents in privately operated residential care facilities...shall have all of the following personal rights:To have a reasonable level of personal privacy in accommodations. This requirement was not met as evidenced by:
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Per Licensee will conduct an inservice training regarding resident privacy rights. Licensee will submit a training log to LPA by POC January 15, 2025.
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Based on interviews facility staff walked into R1's room wihout knocking and/or without R1's consent. This posed a potential personal rights risk to 1 in 1 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: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7