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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603643
Report Date: 10/20/2023
Date Signed: 10/20/2023 04:34:57 PM

Unsubstantiated


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
09/25/2023 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20230925091541
FACILITY NAME:ST. PAUL'S PLAZAFACILITY NUMBER:
374603643
ADMINISTRATOR:STRATMAN, KIMFACILITY TYPE:
740
ADDRESS:1420 E PALOMAR STREETTELEPHONE:
(619) 591-0600
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:300CENSUS: 153DATE:
10/20/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Community Manager, Maria SanoTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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9
Facility retained resident involuntarily
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA met with Community Manager, Maria Sano and shared findings.

The Department investigated the above-listed complaint allegation. The investigation consisted of staff interviews and a detailed review of relevant records.

On September 25, 2023, Community Care Licensing (CCL) received a complaint alleging that Resident #1 (R1) was retained at the facility involuntarily. Facility staff were provided with Confidential Names Form (LIC 811) in order to identify R1. A review of facility records indicated that R1’s Admissions Agreement was signed on March 30, 2019, by their Durable Power of Attorney (DPOA)/responsible party. R1’s physician’s report and care plan indicated that R1 was diagnosed with dementia and required assistance with activities of daily living and medication management. In addition, records disclosed that R1 was conserved. R1 passed away on September 2, 2021, with a documented diagnosis and cause of death of senile degeneration of the brain.
(continue at LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
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-20230925091541
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: ST. PAUL'S PLAZA
FACILITY NUMBER: 374603643
VISIT DATE: 10/20/2023
NARRATIVE
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continue from LIC 9099

Interviews with facility staff indicated that they had no knowledge or indication of R1 or any other resident being kept at the facility against their will. Attempted interviews with R1’s DPOA were unsuccessful. However, a review of official correspondence between R1’s DPOA and facility management indicated R1’s needs and services plan were approved by the DPOA. There was no corroborating evidence found from staff interviews and reviews of all available records to support the allegation.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Community Manager, Maria Sano, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) was provided at the conclusion of the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2