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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604092
Report Date: 11/21/2022
Date Signed: 11/21/2022 11:25:47 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
10/26/2022 and conducted by Evaluator Elizabeth Hamilton
COMPLAINT CONTROL NUMBER: 08-AS-20221026161446
FACILITY NAME:SENIOR LIVING NORWOODS HACIENDAFACILITY NUMBER:
374604092
ADMINISTRATOR:PETROSYAN, ANNAFACILITY TYPE:
740
ADDRESS:35 EL RANCHO VISTATELEPHONE:
(818) 284-2502
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:6CENSUS: 6DATE:
11/21/2022
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Head Caregiver, Jonathan TorresTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility staff did not treat resident with respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced complaint investigation visit at the facility. LPA was greeted at the front entrance by Caregiver, Elena Marrufo and granted entry after identifying herself. LPA met with Head Caregiver, Jonathan Torres and explained the purpose of the visit which was to deliver findings for the above allegation.

The Department’s investigation consisted of record reviews, interviews with staf, residents and outside sources.

On October 26, 2022, it was alleged that sometime during the month of October 2022, staff did not treat a resident with respect. It was specifically alleged that, resident 1 (R1) asked staff 1 (S1) for help and was ignored and called a rude name. Then, on October 25, 2022, it was alleged R1 woke staff 2 (S2) up to request Tylenol sometime late in the night and S2 expressed anger towards R1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
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-20221026161446
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: SENIOR LIVING NORWOODS HACIENDA
FACILITY NUMBER: 374604092
VISIT DATE: 11/21/2022
NARRATIVE
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Interviews with S1 and S2 denied the allegation and maintained there were no incidents where they were disrespectful, upset or rude to any of the residents. Interview with Administrator confirmed there were no complaints or concerns from residents regarding any of the staff being disrespectful. Interviews with residents and outside sources confirmed there were no concerns or witnessed incidents with staff not treating residents with respect during this time. There was no additional evidence provided during this investigation to support this allegation.

The Department has investigated the allegation listed above. Based on evidence obtained, including interviews and records reviewed, the above allegation is determined to be unsubstantiated as the Department could not meet the preponderance of the evidence standard. An exit interview was conducted with Head Caregiver, Torres and a copy of this report and Licensee/Appeals Rights (LIC 9058 01/16) was provided.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2