374603112-11-12-2021-08-AS-IESA-C9A44X-20211130174704

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603112
Report Date: 11/12/2021
Date Signed: 11/12/2021 03:40:24 PM

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
09/02/2021 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20210902152020

FACILITY NAME:	TWAIN RESIDENTIAL CARE, LLC		FACILITY NUMBER:	374603112
ADMINISTRATOR:	SIMSUANGCO, LEONARDO		FACILITY TYPE:	740
ADDRESS:	4626 TWAIN AVE		TELEPHONE:	(619) 281-8337
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92120
CAPACITY:	12	CENSUS: 12	DATE:	11/12/2021
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Caregiver Loida Sanga and Administrator Leonardo Simsuangco		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Licensee interfered with resident's guardianship.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced complaint visit to deliver a finding regarding the above allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Loida Sanga. Administrator Leonardo Simsuangco joined LPA via phone during the visit.

The Reporting Party (RP) alleged that Resident #1 (R1) in the past had a guardian [i.e. Person #1 (P1)], and that Licensee removed P1 as R1’s guardian and was obscuring their name and contact information from R1’s medical provider. The Department’s investigation consisted of an unannounced tour of the facility, interviews of relevant residents, staff, and outside sources, and a review of pertinent facility, legal, and hospital records.

[CONTINUED ON LIC 9099-C, 1 of 2]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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-20210902152020

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: TWAIN RESIDENTIAL CARE, LLC	FACILITY NUMBER: 374603112
	VISIT DATE: 11/12/2021

NARRATIVE

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[CONTINUED FROM LIC 9099]

According to the San Diego County Office of the Public Administrator / Public Guardian, R1 is not conserved, but in the past, had a temporary guardian. Their office formally reassessed R1 in 2020, and determined that R1 no longer met criteria for guardianship. CCLD determined that the phone number provided for P1 was correct, by verifying it against multiple outside sources. However, multiple attempts to reach P1 on separate days all led to a non-working telephone number.

R1 has lived at the facility since 2020, and their spouse, Resident #2 (R2), has lived at the facility since 2016. By the time frame of the Department’s investigation in September 2021: R1 was cognitively impaired but remained alert and able to express basic opinions in simple sentences, and R2 was oriented to person, place, time, and reality. Staff and outside sources unanimously reported being unable to contact P1, and that P1 had zero involvement with either R1 or R2 during the entirety of their stay at the facility. Interviews with R1, R2, and a credible outside source [Person #2 (P2)] revealed that P1 was a former friend, who R1 no longer trusts nor wishes to associate with. R2 and P2 stated they did not believe that P1 was ever R1’s conservator or guardian, even in the past.

Per interview of Licensee: a) at time of R1’s move in, licensee was completely unaware of who P1 was, b) at time of R1’s move in, R1 was ambulatory, able to drive a car, able to manage their own finances, and cognitively independent, and c) much later during R1’s tenure at the facility, R1 revealed to licensee that P1 was a temporary guardian who was assigned to R1 following an acute fall which R1 suffered at their private residence before move-in to the facility, and that P1 was no longer R1’s guardian. Interviews, admissions agreements, and facility records corroborated: a) R1 was the payee and responsible party for R2 during the many years R2 resided at the facility, b) R1 was their own payee and responsible party when they later moved in, and c) Until around March 2021, R1 had been correctly paying rent to the facility for many years. Licensee thus had no reason to suspect R1 should have a guardian or responsible party other than themselves.

[CONTINUED ON LIC 9099-C, 2 of 2]

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20210902152020

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: TWAIN RESIDENTIAL CARE, LLC	FACILITY NUMBER: 374603112
	VISIT DATE: 11/12/2021

NARRATIVE

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[CONTINUED FROM LIC 9099-C, 1 of 2]

According to multiple interviews, by September 2021, R1 and R2 had run out of paper checks, had run low on funds, and were nearly six months behind on rent to the facility. Licensee stated he was committed to the welfare of R1 and R2 and was emotionally unwilling to pursue eviction. On August 24, 2021, Licensee made his facility available as a meeting place so that R2 could designate P2 as their Power of Attorney (POA), and to have said document notarized on-site. This action benefited both R2 and Licensee. [R1 still did not have a POA as of that date.]

Based on records and interviews, a preponderance of evidence does not exist to support the allegation that Licensee interfered with resident’s guardianship. The allegation is therefore unsubstantiated. An exit interview was conducted with Sanga and Simsuangco. A copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided to the administrator via E-mail.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC9099 (FAS) - (06/04)

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