374604057-10-26-2023-08-AS-DPOL-CX5MZE-20231031100301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604057
Report Date: 10/26/2023
Date Signed: 10/26/2023 08:34:44 AM

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
05/18/2023 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20230518123728

FACILITY NAME:	PLATEAU VILLAGE MEMORY CARE		FACILITY NUMBER:	374604057
ADMINISTRATOR:	AYERSMAN, JENNIE		FACILITY TYPE:	740
ADDRESS:	4960 MILLS STREET		TELEPHONE:	(619) 644-1100
CITY:	LA MESA	STATE: CA	ZIP CODE:	91941
CAPACITY:	0	CENSUS:	DATE:	10/26/2023
		UNANNOUNCED	TIME BEGAN:	08:03 AM
MET WITH:			TIME COMPLETED:	08:04 AM

ALLEGATION(S):

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Staff do not allow residents access to their bedrooms
Staff speak inappropriately in the presence of residents
Staff forces resident to eat

INVESTIGATION FINDINGS:

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On May 18, 2023 the Department received an Anonymous phone call from the reporting party. The allegations included staff not allowing residents access to their bedrooms, staff speaking inappropriately in the presence of residents, and staff forcing residents to eat. The purpose of this investigation was to gather evidence and determine the validity of these allegations.

Allegation: Staff do not allow residents access to their bedrooms. Findings: During the investigation, interviews were conducted staff members. It was found that there were no instances where staff denied residents access to their bedrooms.

Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230518123728

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: PLATEAU VILLAGE MEMORY CARE	FACILITY NUMBER: 374604057
	VISIT DATE: 10/26/2023

NARRATIVE

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Allegation: Staff speak inappropriately in the presence of residents. Interviews were conducted staff members to gather information regarding this allegation. It was discovered that there was an incident where staff members engaged in inappropriate conversation in the presence of residents. However, it was determined that this instance was isolated and not reflective of the overall behavior of the staff and did not affect the residents in an adverse manner. The facility has policies in place to address such behavior, and appropriate disciplinary actions were taken against the staff members involved.

Allegation: Staff forces residents to eat. Interviews were conducted with staff members to investigate this allegation. It was found that there were no instances where staff members forced residents to eat against their will. The facility has a well established mealtime routine, and staff members encourage residents to eat but do not force them.

Based on the investigation findings, it can be concluded that the allegations of staff not allowing residents access to their bedrooms and staff forcing residents to eat are unsubstantiated. However, there was an instance where staff spoke inappropriately in the presence of residents, although it was not a widespread issue. A finding that is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

A copy of this report and Licensee's Rights (LIC 9058 03/22) were mailed to the last known address for the facility.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC9099 (FAS) - (06/04)

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