374603182-6-30-2023-08-AS-LTEZ-CTAU8Z-20230630152223

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603182
Report Date: 06/30/2023
Date Signed: 06/30/2023 10:48:10 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
03/20/2023 and conducted by Evaluator Dawn Segura

COMPLAINT CONTROL NUMBER: 08-AS-20230320105417

FACILITY NAME:	RAMONA SENIOR MANOR		FACILITY NUMBER:	374603182
ADMINISTRATOR:	GALANG, MARJORIE C.		FACILITY TYPE:	740
ADDRESS:	1236 D STREET		TELEPHONE:	(760) 440-9844
CITY:	RAMONA	STATE: CA	ZIP CODE:	92065
CAPACITY:	28	CENSUS: 17	DATE:	06/30/2023
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Faizan Jamil, Business Director		TIME COMPLETED:	10:52 AM

ALLEGATION(S):

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Staff did not accord resident with dignity.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigative findings. LPA introduced herself, was granted entry into the facility, and met with Faizan Jamil, Business Director, to whom she disclosed the reason for the visit.

Community Care Licensing (CCL) has investigated the above listed complaint allegation. The investigation consisted of a tour of the facility, review of facility records, and interviews of residents and staff.

It was reported to CCL that Resident 1 (R1) was not being treated with dignity by facility staff. It was alleged that staff were leaning on R1 and getting in his/her face to wake R1 up in the mornings and being physically aggressive with R1 while providing care. At the time the complaint was lodged, two names were provided as the person who possibly engaged in the alleged behavior. During the investigation, it was discovered that there is no one who works in the facility with the same name as the first name provided.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

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-20230320105417

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: RAMONA SENIOR MANOR	FACILITY NUMBER: 374603182
	VISIT DATE: 06/30/2023

NARRATIVE

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There is one staff person who has the same name as the second name provided; however, through interview, R1 expressed that the person who allegedly engaged in the behavior does not work at the facility and expressed that the person works somewhere else. Other interviews conducted yielded no information to corroborate the allegation.

Due to a lack of sufficient evidence to conclude otherwise, the foregoing allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Faizan Jamil, and a copy of this report was provided to the Business Director, whose signature below confirms receipt of copies of this report and Licensee Rights (LIC 9058).

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

LIC9099 (FAS) - (06/04)

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