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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603230
Report Date: 11/16/2022
Date Signed: 11/16/2022 01:11:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/14/2022 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20221114141423
FACILITY NAME:ROYAL CREST RANCH HOMEFACILITY NUMBER:
374603230
ADMINISTRATOR:VERZOSA, DIONISIAFACILITY TYPE:
735
ADDRESS:2628 ROYAL CREST DRIVETELEPHONE:
(760) 658-6891
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 5DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Dionisia Verzosa, Licensee TIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Illegal Eviction.
INVESTIGATION FINDINGS:
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On November 16, 2022, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an unannounced visit to investigate the above allegation. LPA met with Dionisia Verzosa who was informed of the purpose of the visit. During the investigation, LPA interviewed Resident #1 Responsible party, interviewed Licensee, and reviewed resident records.
Regarding the allegation “Illegal Eviction”, it was alleged Resident #1 (R1) was evicted without proper notice. Interview with R1 Responsible Party (RP) revealed no eviction notice was received for R1. Interview with R1 responsible party (RP) also revealed R1 wasn’t allowed to return to the facility after being discharged from hospital and R1 wasn’t given enough time to find another home. LPA interviewed Licensee who stated R1 needed a higher level of care than the facility could provide. Licensee stated R1 Responsible Party was notified via text message on November 4,2022 that R1 is not allowed back to the facility due to sudden change in R1 behavior.
Based on LPA interviews, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division & Chapter number 6) are being cited on the attached LIC9099D). An exit interview was conducted, and a copy of this report was reviewed and provided along with appeal rights to Dionisia Verzosa.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 18-AS-20221114141423
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ROYAL CREST RANCH HOME
FACILITY NUMBER: 374603230
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/25/2022
Section Cited
CCR
85068.5(d)
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Eviction Procedures
(d) The licensee shall, upon completion of the procedures specified in (a) or (b) above, notify or mail a copy of the notice to quit to the client's authorized representative if any.
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Licensee, Dionisia Verzosa stated a 30day eviction notice will be sent to R1 responsible party by the POC due date 11/25/2022.
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This requirement is not met based as evidence by interview. The licensee did not comply with the section cited above by not following the eviction procedure which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/14/2022 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20221114141423

FACILITY NAME:ROYAL CREST RANCH HOMEFACILITY NUMBER:
374603230
ADMINISTRATOR:VERZOSA, DIONISIAFACILITY TYPE:
735
ADDRESS:2628 ROYAL CREST DRIVETELEPHONE:
(760) 658-6891
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 5DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Dionisia Verzosa, Licensee TIME COMPLETED:
01:20 PM
ALLEGATION(S):
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9
Facility did not safe guard resident's property.
INVESTIGATION FINDINGS:
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On November 16,2022, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an unannounced visit to investigate the above allegation. LPA met with Dionisia Verzosa who was informed of the purpose of the visit. During the investigation, LPA interviewed Resident #1 (R1) Responsible party, interviewed Licensee, and conducted an inspection of resident’s bedroom.
Regarding the allegation “Facility did not safeguard resident's property”. Interview with Resident #1 Responsible Party (RP) revealed RP has not been contacted to pick up R1 property. LPA interviewed Licensee who stated R1 property is packed and safe in R1 bedroom waiting for R1 Responsible Party to pick up. LPA inspected R1 bedroom and observed a bag and a box packed with R1 belongings safe in R1 bedroom.
Based on LPA interview with staff and inspection of resident’s bedroom, there is not enough evidence to support the allegation “Facility did not safeguard resident's property”. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Dionisia Verzosa.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3