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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603465
Report Date: 03/21/2025
Date Signed: 03/21/2025 04:11:04 PM

Substantiated


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
03/14/2025 and conducted by Evaluator Iby Strong
COMPLAINT CONTROL NUMBER: 08-AS-20250314155754
FACILITY NAME:RENOWN SUITESFACILITY NUMBER:
374603465
ADMINISTRATOR:MICHELLE RETZERFACILITY TYPE:
740
ADDRESS:8702 TOMMY DR.TELEPHONE:
(619) 466-9924
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY:6CENSUS: 6DATE:
03/21/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Adminsitrator MIchelle RetzerTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did not seek medical care for Resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to initiate a complaint investigation regarding the above-mentioned allegation. LPA identified herself and discussed the purpose of the visit with caregiver Jesus “Patty” Olivera. Administrator Michelle Retzer arrived shortly after.

On March 14, 2025, Community Care Licensing (CCL) received a complaint alleging staff did not provide medical care for Resident 1 (R1). Physician’s Report dated January 30, 2025, confirmed R1 was diagnosed with a major neurocognitive impairment and had a bladder/bowel impairment. Records collected also confirmed R1 was receiving end-of-life services from an outside source agency.

According to the allegation, staff did not provide medical attention to R1 when such resident did not have a bowel movement for eleven days. Records collected revealed that outside source agency requires facility to report when resident does not have a bowel movement for two days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
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 5
Control Number 08-AS-20250314155754
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: RENOWN SUITES
FACILITY NUMBER: 374603465
VISIT DATE: 03/21/2025
NARRATIVE
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Records collected confirmed that R1 did not have a bowl movement from January 29, 2025, until February 12, 2025, when medical attention was provided. Interview with Administrator revealed that there was miscommunication between staff, responsible party and medical providers which resulted in no medical care for constipation. Interview with outside source agency revealed that they were unaware R1 had not had a bowel movement for the extended period. Outside source agency also explained that medical attention is required after no bowel movement for 3 days.

Based on interviews conducted and records reviewed a preponderance of evidence exists to support the allegation, therefore it is substantiated. A deficiency is cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted and a Plan of Correction was jointly developed. A copy of this report, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to Administrator Michelle Retzer, signature on this form confirms receipt of documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20250314155754
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: RENOWN SUITES
FACILITY NUMBER: 374603465
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/18/2025
Section Cited
CCR
87465(a)(2)
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Incidental Medical and Dental Care(a)A plan for incidental medical and dental care shall be developed by each facility (2)The licensee shall provide assistance in meeting necessary medical needs.
This requirement was not met as in evidence;
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Adminsitrator states they will complete a training in regardings to resident care and communition between parties involved.
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Based on interviews and records reviewed the licensee did not provide medical care for 1 of 6 residents in care (R1) which posed a potential Health 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: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
03/14/2025 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250314155754

FACILITY NAME:RENOWN SUITESFACILITY NUMBER:
374603465
ADMINISTRATOR:MICHELLE RETZERFACILITY TYPE:
740
ADDRESS:8702 TOMMY DR.TELEPHONE:
(619) 466-9924
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY:6CENSUS: 6DATE:
03/21/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Adminsitrator MIchelle RetzerTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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9
Staff did not provide incontinence care
Licensee did not issue a refund
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to initiate a complaint investigation regarding the above-mentioned allegations. LPA identified herself and discussed the purpose of the visit with caregiver Jesus “Patty” Olivera. Administrator Michelle Retzer arrived shortly after.

On March 14, 2025, Community Care Licensing (CCL) received a complaint alleging staff do not provide incontinence care and licensee did not issue a refund. Physician’s Report dated January 30, 2025, confirmed R1 was diagnosed with a major neurocognitive impairment and had a bladder/bowel impairment. Records collected also confirmed R1 was receiving end-of-life services from an outside source agency.

According to the allegation, on R1’s first days at the facility R1 was left in soiled clothing for an extended period. Interview with staff present established that all residents are changed every 2 hours and rotated. Interview with Administrator corroborated that staff frequently change resident’s who have incontinence.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20250314155754
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: RENOWN SUITES
FACILITY NUMBER: 374603465
VISIT DATE: 03/21/2025
NARRATIVE
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Interview with an outside source revealed that R1 did not have any physical signs that R1 was left soiled for an extended period of time.

It was also alleged that licensee did not issue a refund. LPA Strong reviewed final itemized receipt of services and observed R1’s responsible party was issued $2402.08 refund via check mailed. Based on signed Admissions Agreement and itemized receipt, the correct refund was issued. Interview with Administrator confirmed that refund was issued within time frame necessary.

Based on the interviews, and record reviews there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted and a copy of this report and Appeal and Licensee Rights (LIC 9058 03/22) were provided to the Administrator.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5