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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603713
Report Date: 04/11/2025
Date Signed: 04/11/2025 04:56:06 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
01/04/2024 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20240104102521
FACILITY NAME:PARKVIEW MEMORY CARE AT PARADISE VILLAGEFACILITY NUMBER:
374603713
ADMINISTRATOR:AGUILAR, GEOVANNIFACILITY TYPE:
740
ADDRESS:735 ARCADIA AVENUETELEPHONE:
(619) 475-5040
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:70CENSUS: 47DATE:
04/11/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Interim Executive Director, Nicole LongTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Questionable Death
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to deliver investigative findings. LPA met with Interim Executive Director, Nicole Long, and shared findings.

The Department investigated the above-listed complaint allegation. The investigation consisted of observations, interviews with facility staff and outside sources, and a detailed review of relevant records, such as investigative law enforcement reports, residents’ medical records, and service care plans.

On January 4, 2024, Community Care Licensing (CCL) received a complaint alleging the questionable death of a resident (R1), on December 21, 2023. It was specifically alleged that on December 14, 2023, staff did not provide care and supervision to meet residents' needs which resulted in R1 succumbing to injuries sustained from a possible assault by another resident (R2) [staff was provided LIC 811 Confidential Name List to identify the residents].
(Continue at LIC9099C)

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
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 3
Control Number 08-AS-20240104102521
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: PARKVIEW MEMORY CARE AT PARADISE VILLAGE
FACILITY NUMBER: 374603713
VISIT DATE: 04/11/2025
NARRATIVE
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(Continue from LIC9099)

Based on records review and interviews with relevant witnesses it was indicated that on December 14, 2023, there was an incident involving R1 and R2. At 6:15 a.m. during safety checks, staff observed R1 lying on the floor in R2’s room. Per staff interviews, there were no witnesses of the incident. Staff obtained immediate medical attention by emergency medical responder personnel for R1 who was transferred to the hospital via ambulance. A detailed review of R1 and R2’s medical records indicated that both residents were diagnosed with dementia and were under memory service care plans. In addition, both residents had a history of “sundowning” (confusion, anxiety, agitation, or aggression that can occur in the late afternoon or early evening) behavior.

R1 was non-ambulatory and needed assistance to transfer in and out of bed. R1’s primary diagnosis was Parkinson’s disease; R1 did not have inappropriate or aggressive behavior but was confused/disoriented. R2 was ambulatory and able to independently transfer in and out of bed. R2’s medical records under “mental condition” the box for “Confused/Disoriented” was marked as “yes”. For inappropriate and aggressive behavior, the box was marked as “no”. In addition, both residents were in neighboring rooms, sharing a “Jack and Jill” adjoining bathroom. A review of the admission agreements and the pre-admission assessments for R1 and R2 indicated that they both were new residents (R1 was admitted on 11/18/2023 and R2 was admitted on 11/29/2023), to the facility with no history of aggressive or violent behavior.

All the staff that worked on December 14, 2023, were interviewed on the date of the incident. The responsible parties of both residents were interviewed as well as an attempted interview with R2 was conducted on December 14, 2023. Due to R2’s documented dementia medical condition, they were not able to provide relevant details of the incident. Based on interviews with the assigned investigator with the County of San Diego Medical Examiner’s Office, the incident was ruled as “accidental” by the Medical Examiner’s Office. A review of relevant medical reports indicated that R1’s physician stated that R1’s cause of death was determined as blunt force trauma to their head. It was determined there were no witnesses to what, if anything, had occurred directly between residents R1 and R2, such as a physical altercation. According to interviews conducted with facility staff safety check protocols were adhered to during the shift when the event occurred. Safety check logs were obtained and reviewed which confirmed the required documentation of the safety checks.
(Continue at LIC9099C)
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20240104102521
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: PARKVIEW MEMORY CARE AT PARADISE VILLAGE
FACILITY NUMBER: 374603713
VISIT DATE: 04/11/2025
NARRATIVE
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(Continue from LIC9099C)

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

An exit interview was conducted with Interim Executive Director, Nicole Long, to whom a copy of this report, LIC811 Confidential Name List, and the Licensee Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3