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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603643
Report Date: 07/19/2022
Date Signed: 07/19/2022 11:13:33 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
02/11/2020 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20200211084533
FACILITY NAME:ST. PAUL'S PLAZAFACILITY NUMBER:
374603643
ADMINISTRATOR:CAMPBELL, RHONDAFACILITY TYPE:
740
ADDRESS:1420 E PALOMAR STREETTELEPHONE:
(619) 239-6900
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:300CENSUS: 154DATE:
07/19/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Executive Director. Kim StratmanTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Staff did not give resident medication as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. The LPA was greeted by Executive Director, Kim Stratman, identified himself, and disclosed the purpose of the visit.

The Department’s investigation consisted of review of records, and interviews with internal and external sources.

It was alleged staff did not give resident medication as prescribed. Records obtained by the Department revealed R1 did not required any assistance with medication management. Interviews with internal and external sources corroborated R1 was independent and was not receiving personal care services, to include assistance with medication management. Based on the evidence gathered throughout the investigation, there is not a preponderance of evidence to prove the alleged violation occurred, therefore, the allegation is unsubstantiated.
.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022
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 2
Control Number 08-AS-20200211084533
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: ST. PAUL'S PLAZA
FACILITY NUMBER: 374603643
VISIT DATE: 07/19/2022
NARRATIVE
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An exit interview was conducted with Executive Director, Kim Stratman, to whom a copy of this report along with the licensee Rights (LIC 9058 01/16 ) were provided to
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2