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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602972
Report Date: 07/15/2025
Date Signed: 07/15/2025 09:51:12 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRALIZED APP UNIT, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/15/2021 and conducted by Evaluator Donna Teutschel
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20210615122559
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:
07/15/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Maria ShetlerTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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9
Staff neglect resulted in injury to resident
Facility staff did not meet resident’s incontinence care
Facility staff did not meet resident’s care needs
Facility did not maintain a clean and sanitary room for resident
INVESTIGATION FINDINGS:
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LPM II RA, Donna Teutschel conducted a telephone conference with Administrator, Maria Shetler regarding the above allegations. Resident no longer at facility. Based on the information received to date, the Department is unable to prove or disprove the allegations and findigs are determined to be Unsubstantiated..


Administrator email: MARIA.SHETLER@PLAZAVILLAGE.COM
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stacy Barlow
LICENSING EVALUATOR NAME: Donna Teutschel
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
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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