374603713-10-29-2021-08-AS-DPOL-C8BNMW-20211031103545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603713
Report Date: 10/29/2021
Date Signed: 10/29/2021 01:54:15 PM

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
02/12/2021 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20210212104406

FACILITY NAME:	PARKVIEW MEMORY CARE AT PARADISE VILLAGE		FACILITY NUMBER:	374603713
ADMINISTRATOR:	LAWSON, WILLIAM		FACILITY TYPE:	740
ADDRESS:	735 ARCADIA AVENUE		TELEPHONE:	(619) 475-5040
CITY:	NATIONAL CITY	STATE: CA	ZIP CODE:	91950
CAPACITY:	70	CENSUS: 44	DATE:	10/29/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator, Geovanni Aguilar		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident kept at facility against their will
Staff did not obtain medical care for resident
Staff did not meet the residents needs
Staff handled resident in a rough manner
Facility staff did not treat resident with respect
Staff yelled at resident
Licensee limited the resident access to the telephone.
Facility staff did not respect resident’s wishes

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to deliver findings on the above-mentioned allegations. LPA was met by name Vivian Magumen, Receptionist, and was granted entry into the facility. LPA met with Administrator, Geovanni Aguilar, and discussed the purpose of the visit.

Investigation consisted of interviews with staff, outside sources and residents, review of records, and a tour of the facility.

It was alleged that Resident #1 (R1) was kept at the facility against their will. Administrator was provided with Confidential Names Form (LIC 811) in order to identify R1. Review of facility records indicated that R1’s Admissions Agreement was signed by their responsible party.

Continue next page

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021

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 6

Control Number 08-AS-20210212104406

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: PARKVIEW MEMORY CARE AT PARADISE VILLAGE	FACILITY NUMBER: 374603713
	VISIT DATE: 10/29/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

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 not conserved. During the course of the investigation, on March 17, 2021, the Department was notified that R1 was discharged from the facility and living at private home under the care of a family member. On April 21, 2021, an attempted interview with R1 was unsuccessful. Interviews with facility staff and the Administrator indicated that they had no knowledge or indication of any resident being kept at the facility against their will. Attempted interviews with other residents were unsuccessful due to their cognitive limitations. There was no corroborating evidence from outside source interviews to support the allegation.

It was also alleged that facility staff did not obtain medical care for R1 when they complained of pain. Review of facility case notes for R1 disclosed that on March 4, 2021, during lunch while sitting in the dining room table, R1 became agitated and tried to move away from the table and hit their wrist and sustained a skin tear on their right elbow. Facility staff cleansed and bandaged the area and evaluated R1 for full range of motion and R1 was able to move arm and wrist with no pain. In addition, facility staff reported incident to facility management and to R1’s responsible party. Interviews with staff who witnessed the incident corroborated the notes in the daily log. Based on the assessment completed by facility staff it was determined that no further medical attention was warranted as they continued to monitor R1’s condition throughout the day following the incident. Staff stated that they observed R1 to be calm, showing no symptoms of pain when moving arms and hands and that R1 was able to eat their dinner with no pain. Interview with outside sources confirmed knowledge of the incident. On March 5, 2021, a visitor called the police to report suspected physical abuse because they had observed a bruise on R1’s wrist and a skin tear on R1’s elbow. Law enforcement responded to the call and interviewed R1 and their visitor as well as the facility staff that were present during the incident including the Administrator. Interviews indicated R1 had sustained the injury the day before during a dining room incident. The investigation obtained corroborating evidence from the National City Police Department incident report which stated, “incident was unfounded”.

Continue next page

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 08-AS-20210212104406

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: PARKVIEW MEMORY CARE AT PARADISE VILLAGE	FACILITY NUMBER: 374603713
	VISIT DATE: 10/29/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The dispatch unit reported no official police report was filed because the police officer determined there was no suspicion of abuse. In addition, the Administrator stated, R1 was picked up from the facility by a family member on March 8, 2021, to be taken to a doctor’s appointment, and there was no change in R1’s care plan. Contact with R1’s primary doctor showed no record of R1 being seen by the doctor during the month of March 2021.

It was also alleged that staff did not meet R1’s needs. Facility records indicated that R1 needed assistance with activities of daily living (ADLs), such as toileting, bathing, dressing. Outside source interviews revealed the care R1 received at the facility was meeting R1’s needs as outlined on R1’s care plan. Residents in care were observed to be groomed, clean, dressed in appropriate attire, and showed no signs of neglect. Attempted interviews with residents in care were unable to provide credible information. During interviews, direct care staff described the care and supervision being consistent with R1’s care plan.

It was also alleged that R1 was handled in a rough manner. R1 complained to an outside source of pain on their wrist because they had landed on their hand when staff pushed them during incontinence care. Interview with outside sources indicated they had observed a bruise on R1’s wrist and reported it to the local law enforcement. Interviews with staff and outside sources indicated the bruise was self-inflicted when R1 became agitated in the dining room and hurt their wrist when they pushed themselves off the dining room table on March 4, 2021. Staff interviews reported having no knowledge of or having witnessed any staff member handling residents in a rough manner. Staff members indicated that they seek assistance when two (2) person transfers are required for incontinence care to ensure the safety of both the residents and staff. Administrator confirmed no staff member had reported any abuse observed by any staff members. Staff interviews acknowledged if any abuse or mistreatment of residents were observed, they would immediately report any suspected abuse, and reporting requirements would be followed.

Continue next page

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 08-AS-20210212104406

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: PARKVIEW MEMORY CARE AT PARADISE VILLAGE	FACILITY NUMBER: 374603713
	VISIT DATE: 10/29/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

It was also alleged that R1 was not treated with respect, as they were allegedly pushed into the elevator by staff member. An interview with an outside source indicated that during a telephone conversation with R1, R1 related to them that a staff member had pushed R1 into the elevator because the staff member got mad when R1 refused to eat dinner. The dates and/or times of when this occurred or of any other examples of when R1 was not treated with respect was not identified. LPA was unable to obtain credible information from resident interviews corroborating this allegation. Interviews with staff indicated they have not seen or witnessed a staff member pushing a resident into the elevator or of any staff member not treating residents with respect.

It was also alleged that staff yelled at R1 to get off the phone on or around February 2, 2021. Interviews with staff reported that there are no time limits to phone calls and that residents can stay on the phone for as long as they want. Staff also reported having no knowledge of or having witnessed any staff member yelling at residents. They indicated that at times when residents have a hearing loss, they need to raise their voice so that the residents can hear them. Interview with Administrator confirmed no staff member reporting any yelling observed by any staff members. Interviews with outside sources indicated that they have not witnessed or have knowledge of staff yelling at R1. In addition, outside sources indicated they never experienced being rushed during their phone conversation with R1 nor being denied telephone access to R1. LPA was unable to obtain credible information from resident interviews.

It was also alleged that R1’s access to the telephone was limited by staff on or about February 12, 2021. It was reported that staff would consistently tell the caller that R1 was not available because either R1 was sleeping, eating or agitated for unknown reasons and could not come to the phone. Interviews with staff reported that the facility does not have time limits for telephone calls and that all phone calls from friends and/or family members are facilitated by staff whenever possible.

Continue next page

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 08-AS-20210212104406

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: PARKVIEW MEMORY CARE AT PARADISE VILLAGE	FACILITY NUMBER: 374603713
	VISIT DATE: 10/29/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The calls are routed from the reception clerk to the Medical Technician on duty, then to the caregiver assigned to the resident receiving the phone call. The caregiver would then bring the resident to the library and the call would be transferred to the designated telephone in the library. Other times portable phones would be taken to the residents’ rooms. During an interview with the Administrator it was indicated that R1 would often receive calls as early as 6:00 a.m. or as late as 10:00 p.m. when the resident was sleeping. Facility staff explained to the caller on several occasions that the reception desk hours were from 8:00 a.m. to 8:00 p.m. and that this time frame was the ideal time to call the residents when they were awake and alert. Although calls were allowed outside reception hours, Administrator stated that the caller would get irritated and would complain when they call and R1 was not available to talk on the phone, indicating that they were not available to call during the reception hours. Interviews with other outside sources indicated no problems getting in touch with R1 via telephone. LPA was unable to obtain credible information from resident interviews.

Lastly, it was alleged that facility staff did not respect resident’s wishes as R1 did not want to participate in group activities and preferred to go to their room to take a nap. Outside source stated that they wished facility staff would leave R1 alone and let R1 sleep all the time they want. During staff interviews, it was reported that if residents do not wish to participate in any one activity they do not have to. Staff try to encourage residents to participate in activities. They provide different activity options for residents to pick from if they do not want to participate in the scheduled activity. Interviews with outside sources reported that R1 had not complained to them about staff forcing R1 to participate in activities. LPA observed residents in care participating in different activities but was unable to obtain credible information from resident interviews.

Continue next page

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 08-AS-20210212104406

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: PARKVIEW MEMORY CARE AT PARADISE VILLAGE	FACILITY NUMBER: 374603713
	VISIT DATE: 10/29/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The Department has investigated the above-mentioned allegations and has found that based upon interviews, record reviews, and observations, there is insufficient evidence to corroborate the allegations. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, these allegations are deemed to be unsubstantiated.

An exit interview was conducted with Administrator Aguilar and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC9099 (FAS) - (06/04)

Page: 6 of 6