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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604170
Report Date: 07/10/2025
Date Signed: 07/10/2025 12:32:07 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
04/18/2025 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20250418091140
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: 5DATE:
07/10/2025
UNANNOUNCEDTIME BEGAN:
12:19 PM
MET WITH:Martha Collins, House ManagerTIME COMPLETED:
12:31 PM
ALLEGATION(S):
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Staff mishandled the clients medications while in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Tiffany Holmes and Ramin Hashemi conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegation. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Martha Collins, House Manager

It was alleged that staff mishandled the clients medications while in care.

CCLD’s investigation involved an unannounced facility tours/welfare checks, interviews of staff, clients and outside sources. The Department also reviewed the LIC602 Physician’s Reports, lists of prescribed medications, and Medication Administration Records (MARs) for all clients.

[CONTINUED ON LIC 9099]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
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-20250418091140
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: 07/10/2025
NARRATIVE
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[CONTINUED FROM LIC 9099]

Per LPA observation: The facility’s locked medication cabinet was organized. The clients’ MARs contained timely and consistent staff initials and documentation.

Interviews of clients, staff, and outside sources revealed there were no known recent medication errors at the facility, nor a pattern of medication errors when looking further back in time. Interviews revealed that the direct care staff that LPA interviewed attested that they previously underwent formal and hands-on training on medication assistance.

Based on records and interviews, a preponderance of evidence does not exist to show that Licensee did not give clients medication as prescribed. The allegation is therefore Unsubstantiated, and no deficiency was cited for it.

An exit interview was conducted with Martha Collins, House Manager, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2