374602972-5-7-2026-08-AS-APAO-DUB65L-20260521203032

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602972
Report Date: 05/07/2026
Date Signed: 05/07/2026 04:01:57 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
01/07/2025 and conducted by Evaluator Jose DeLaCruz

COMPLAINT CONTROL NUMBER: 08-AS-20250107161518

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: 58	DATE:	05/07/2026
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Facility Director Megan Moore		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Faciltiy did not ensure that resident was changed in a timley maner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose De La Cruz conducted an unannounced visit regarding the above mentioned allegation. LPA was greeted and granted entry by Facility Director Megan Moore, to whom he identified himself and explained the purpose of the visit.

The Reporting Party (RP) alleged that the facility did not ensure that Resident 1 (R1) was changed in a timely manner. RP stated that R1 was assessed while in memory care with urine odor, and “bilateral severe moisture related breakdown in the groin.” Attempts to contact RP on 01/14/2025 and 04/14/2026 were unsuccessful. LPA confirmed that RP was no longer employed and their whereabouts could not be determined.

[CONTINUED on LIC9099]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Jose DeLaCruz
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

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-20250107161518

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: 05/07/2026

NARRATIVE

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[CONTINUED FROM LIC9099]

A facility visit was conducted on 01/15/2025, during which LPA interviewed R1. R1 reported that they were able to use the restroom and bathe independently. R1 stated they cleaned themselves and would request assistance if needed but emphasized they were generally independent. R1 acknowledged having a rash in the groin area and receiving treatment but was unsure how the rash developed. During the same visit, five additional residents were interviewed. None reported concerns and all stated they received assistance when requested.

On April 14, 2026, LPA De La Cruz conducted a record review at the facility. R1’s pre placement appraisal dated 05/08/2024 indicated that R1 was toileting independent and required only verbal reminders. A subsequent Medical Assessment dated 07/10/2025—six months after the complaint—documented that R1 remained “able to care for own toileting needs.”

During the April 14, 2026 visit, LPA contacted an outside source familiar with R1 (OS1). OS1 stated they had no knowledge of the incident reported in January 2025. OS1 confirmed that R1 did not require toileting assistance other than reminders approximately every two hours to use the restroom. OS1 expressed confidence that R1 was safe and appropriately cared for at the facility.

Based on records reviewed, interviews with residents, the alleged victim and outside sources, as well as medical and facility records, the information reviewed does not support the allegation that the facility failed to change the resident in a timely manner. The preponderance of evidence standard has not been met, and the allegation is deemed unsubstantiated.

Report and Appeal Rights were discussed with and provided to the Licensee. The Licensee’s signature below confirms receipt.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Jose DeLaCruz
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC9099 (FAS) - (06/04)

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