374602972-7-27-2023-08-AS-LTEZ-CU9W5N-20230731165926

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602972
Report Date: 07/27/2023
Date Signed: 07/27/2023 12:07:33 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
04/11/2023 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20230411141944

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: 65	DATE:	07/27/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Executive Director, Maria Shetler		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Neglect/Lack of Supervision resulting in sexual abuse
Staff did not meet resident's needs
Staff did not treat resident with dignity
Staff did not safeguard resident's belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit. 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 internal and external sources.

It was alleged Neglect/Lack of Supervision resulted in sexual abuse of a resident. On 4/11/2023, the Department received a Report of Suspected Dependent Adult/Elder Abuse reporting Resident # 1 (R1) had reported and unknown male had attempted to get in bed with R1 every night and touched R1 inappropriately. Throughout the Department’s interview of R1, R1 did not recall any similar incident and veered into different topics unrelated to the allegation. An interview with the facility’s Executive Director revealed a new resident had recently wandered into R1’s room and R1 had called for help.
(See LIC 9099-C for continuation of report.)

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: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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-20230411141944

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: 07/27/2023

NARRATIVE

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The resident was seated in R1’s room and was redirected by staff to exit the room. No other similar incidents had been reported, nor had R1 reported inappropriate touching from the new resident.

It was alleged staff did not meet a resident’s needs. It was reported residents were not assisted with showers, appeared dirty, unshaven and appeared to have overgrown nails. Interviews with internal sources revealed the residents had weekly scheduled showers. The only reason why showers were not conducted, was when residents declined to have a shower. Internal and external sources did not reveal any concerns with resident being dirty, unshaven, nor having long nails. On multiple visits to the facility, the LPA did not observe any residents to be dirty, unshaven, nor have dirty nails.

It was alleged Staff did not treat a resident with dignity. It was reported to the department a resident was showered with hot water, left alone resulting in the resident yelling for help, but being ignored by staff. Interviews with Internal sources did not reveal any concerns, nor knowledge of any residents being showered with hot water, nor left alone in the shower and being ignored. Interviews with internal and external sources corroborated R1 would receive weekly showers at a weekly scheduled program and not at the facility.

It was alleged staff did not safeguard a resident’s belongings. It was reported to the Department a Resident’s shoes, hat and money were stolen at the facility. Interviews with internal sources revealed there may have been times when items may have been misplaced, but ultimately located and returned to the residents. Interviews with external sources did not reveal any concerns regarding personal items going missing.
Based on the evidence gathered throughout the investigation, there was not a preponderance of evidence to prove the alleged violations occurred, therefore, 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: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC9099 (FAS) - (06/04)

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