374602972-8-23-2022-08-AS-LTEZ-CJRRTP-20220930131840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602972
Report Date: 08/23/2022
Date Signed: 08/23/2022 10:26:55 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/08/2022 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20220808090541

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: 63	DATE:	08/23/2022
		UNANNOUNCED	TIME BEGAN:	09:53 AM
MET WITH:	Community Relations Director Zack Shetler		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Licensee pursued unlawful eviction of a resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver findings regarding the above prior complaint allegation. LPA was welcomed by and identified himself to Receptionist Mary Maldonado. LPA then met with and discussed the purpose of the visit with Community Relations Director Zack Shetler.

On August 3rd, 2022, licensee arranged transport of Resident #1 (R1) to a hospital emergency room due to their behavioral disturbances. The next day, R1’s responsible party (P1) retrieved all of R1’s possessions from their rented room at the facility. Later, R1 met criteria to be discharged from the hospital, but was unable to return to the facility because their belongings were no longer there. It was alleged that licensee pursued an unlawful eviction of R1 principally because they required P1 to vacate R1’s room without issuing a 30-day eviction notice. CCLD’s investigation involved an unannounced facility tour/welfare check and interviews of R1, P1, facility staff, and multiple outside sources. Pertinent facility care and billing records, E-mails, and text messages were also reviewed. [CONTINUED ON LIC 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

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-20220808090541

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PLAZA VILLAGE SENIOR LIVING	FACILITY NUMBER: 374602972
	VISIT DATE: 08/23/2022

NARRATIVE

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[CONTINUED FROM LIC 9099]

The Department’s investigation uncovered a different narrative. All interviews unanimously corroborated: a) R1 themselves wanted to be transported to the hospital and P1 consented to the transfer; b) In the months leading up to this incident, licensee repeatedly communicated concerns about R1’s escalating behaviors with their responsible party, physician, social worker, and payee; and c) Licensee sought to work collaboratively with the payee to find alternate placement for R1, and so did not issue a 30-day eviction notice.

Interviews and written correspondence revealed that P1 both desired and anticipated that R1 would be directly referred from the hospital to a higher level of specialized care (at a location other than the facility). Seeking to save money, P1 contacted licensee, indicating they wished to vacate R1’s room at the facility to end R1’s prorated rent fees. P1 themselves selected the time and date for the move out, and personally vacated R1’s room on the afternoon of August 4th, 2022. Subsequently, R1 did not meet hospital criteria to be transferred to a higher/specialized care setting. On August 5th, 2022, the hospital tried but could not discharge R1 back to the facility, because R1 no longer was a resident of the facility (in administrative, financial, and practical terms).

The Department concluded that P1 was the primary actor/driver for R1’s move-out; licensee did not force/require them to take such action. Absent P1’s actions, licensee intended to continue reserving R1’s room until they returned, complete with their belongings, and to charge rent fees accordingly (consistent with R1’s admissions agreement contract). While R1 was at the hospital, they also told LPA they did not want to return to the facility because they needed more mental health support than the facility could provide.

Based on interviews and records, while R1’s behaviors were indeed problematic for licensee, there does not exist a preponderance of evidence to prove that licensee unlawfully evicted R1. The allegation is therefore unsubstantiated. An exit interview was conducted with Shetler, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

LIC9099 (FAS) - (06/04)

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