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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604170
Report Date: 08/16/2024
Date Signed: 08/16/2024 10:33:52 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
04/04/2022 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20220404101950
FACILITY NAME:NOR LIVING LLCFACILITY NUMBER:
374604170
ADMINISTRATOR:RZOK, NAJAH JFACILITY TYPE:
735
ADDRESS:9027 AKARD STREETTELEPHONE:
(619) 335-0566
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:6CENSUS: DATE:
08/16/2024
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Martha Collins, House ManagerTIME COMPLETED:
10:40 AM
ALLEGATION(S):
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Facility did not seek medical care.
Neglect/ Lack of Supervision resulting in multiple falls.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Martha Collins House Manager to discuss the purpose of the visit.

LPA’s visit consisted of delivering findings on the above-mentioned allegations.

LPA conducted the initial investigation visit on April 5, 2022 and was able to conduct interviews. LPA also reviewed records, and conducted a physical inspection of the facility. It was alleged that the facility did not seek medical care. Interviews revealed the clients receive medical care when needed. There were times the client did fall but did not need medical attention. Interviews revealed with this fall the client started acting different and by observing this, the staff took the client to this hospital as soon as they observed the change in condition.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
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-20220404101950
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: NOR LIVING LLC
FACILITY NUMBER: 374604170
VISIT DATE: 08/16/2024
NARRATIVE
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Interviews revealed that the client was going through a traumatic time and the stress from the incidents with the father brought on this catatonic stated where the client slowly and heavily decompensated. Interviews revealed the staff did all they could by taking C1 to the doctor and medical appointments along with working with SDRC to get C1 back to their baseline. Interviews revealed after months of rehab and the client being a skilled nursing facility the staff was able to assist the client and bring them all the way back to a normal baseline.


It was alleged neglect/ Lack of Supervision resulting in multiple falls. interviews revealed the staff supervise the clients. There are XX staff with the clients at all times. Facility’s records revealed XX staff being present during the incident in question. Staff denied that the lack of supervision resulted in C1 having multiple falls. LPA reviewed C1s physician report and confirmed that C1 doesNOT require constant supervision. In addition, C1 was unable to be interviewed due to their cognitive state at the time of the first visit.


Based on the evidence obtained from interviews, and record review, the complaint allegations of the facility did not seek medical care and neglect/ Lack of Supervision resulting in multiple falls are found to be unsubstantiated; as there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted with Najah Rzock, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
LIC9099 (FAS) - (06/04)
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