374604105-9-21-2023-08-AS-DPOL-CW8VKN-20231002163037

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604105
Report Date: 09/21/2023
Date Signed: 09/21/2023 01:03:27 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
04/23/2021 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20210423144948

FACILITY NAME:	RENAISSANCE LIVING II		FACILITY NUMBER:	374604105
ADMINISTRATOR:	EDWARDS, RICHARD		FACILITY TYPE:	740
ADDRESS:	12536 JACKSON HILL LN		TELEPHONE:	(619) 334-0143
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY:	6	CENSUS: 6	DATE:	09/21/2023
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Leandra Smith, Caregiver		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Staff financially abused resident
Staff did not safeguard resident's personal property

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close a complaint investigation regarding the above-mentioned allegations. LPA identified herself and met with Leandra Smith, Caregiver, to discuss the purpose of the visit and elements of the complaint.
It was alleged that staff financially abused resident. Interviews revealed Resident 1 (R1) had Dementia that was progressing and they would say things that were not true. Interviews with outside sources stated that the facility staff did not steal any money from the resident and they know because they were R1s responisble party. It was alleged that staff did not safeguard resident's personal property. Interviews with staff revealed they took care of R1 and that when R1 came they did not come with any furniture or extra clothes. Outside source interviews revealed the resident went to the facility with only the clothes on their back and nothing else. Interviews also revealed the facility staff took really good care of R1. Allegations of staff financially abused resident and staff did not safeguard resident's personal property are unsubstantiated.

An exit interview was conducted with Leandra Smith, Caregiver. A copy of this report and Licensee Appeal rights (LIC 9058 3/22)were provided at the conclusion of the visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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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