374604237-8-8-2023-08-AS-DPOL-CV5U44-20230828151431

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604237
Report Date: 08/08/2023
Date Signed: 08/08/2023 12:51:55 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
07/31/2023 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230731112119

FACILITY NAME:	TENDER LOVING CARE HOME FOR ELDERLY		FACILITY NUMBER:	374604237
ADMINISTRATOR:	BORDON, LAURETTA M		FACILITY TYPE:	740
ADDRESS:	165 PALAWAN WAY		TELEPHONE:	(619) 370-8008
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92114
CAPACITY:	4	CENSUS: 4	DATE:	08/08/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Lauretta Bordon, Licensee		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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- Licensee did not allow resident to wear their own clothes
- Licensee did not allow resident to retain their personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility LPA investigated and delivered findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Lauretta Bordon, Licensee. LPA stated the purpose of the visit and reviewed the findings of the complaint with Licensee Bordon.

The Department’s investigation consisted of interviews with staff, resident, and an outside source, records review of relevant documents pertinent to this investigation, and LPA observations. On July 31, 2023, it was alleged that the Licensee did not allow resident to wear their own clothing; and they did not allow resident to retain their personal belongings.

It was specifically alleged that the licensee did not want to have the resident wear their own personal clothing and opted to donate old clothing and purchase new clothing for resident without their consent. Interview with Licensee said that they have accepted three new admissions under an emergency placement from a third-party agency.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

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-20230731112119

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: TENDER LOVING CARE HOME FOR ELDERLY	FACILITY NUMBER: 374604237
	VISIT DATE: 08/08/2023

NARRATIVE

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When they accepted the new residents, each resident was able to retrieve at least two weeks of clothing from their former facility to take with them. If they did not have a needed item, the Licensee was able to purchase the items needed until the residents retrieved their clothing. According to the Licensee, they had two trash bags with donation items that had a few clothing items but disclosed that Resident #1 (R1) and Resident #2 (R2) did not have any items to donate. All the items being donated belonged to another resident, resident #3 (R3). A brief interview with resident #1 (R1) said that they were happy with their attire. Interview with an outside source did not have any immediate concerns as the residents had just arrived at the facility. A review of records revealed that R1 is excellent at advocating their wants and has the ability to speak full sentences and has no problem with communicating. On August 08, 2023, LPA toured the facility and observed that each of the residents’ clothing items were organized in their closet or drawers. The residents clothing items varied in appearance from newer to older items.

It was specifically alleged that the resident’s personal belongings were not allowed into the facility when the resident transitioned into the facility. Interview with Licensee said that as it was an immediate move the residents were unable to take all of their belongings with them, but they were able to take some personal items with them prior to departing from their former facility. A resident’s family member was able move the last of the residents’ belongings from the former facility and take it to the new facility on August 5, 2023. From their move, the residents had two bags of donation items with books, purses, shoes, etc., that R3 opted to donate. R1 and R2 opted to keep all their belongings and had no items for donation. According to Licensee, R1 stored kept items in their closet. Interview with R1 regarding belongings was attempted, but R1 did not want to respond. Interview with an outside source had no immediate concerns. A review of records revealed that R1 is excellent at advocating their wants and has no problem with communicating their needs. On August 08, 2023, LPA toured the facility and observed that the residents’ personal belongings were organized in their room area or stored in their closet with their name labeling their bins.

Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff and outside source interviews, records reviewed, and LPA observations, there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be unsubstantiated.

The report was discussed, and an exit interview was conducted with Licensee Lauretta Bordon. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Licensee Bordon at the conclusion of the visit. The signature below confirms the receipt of these documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC9099 (FAS) - (06/04)

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