374604267-5-5-2023-08-AS-LTEZ-CSCTVB-20230531150337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604267
Report Date: 05/05/2023
Date Signed: 05/05/2023 05:03:42 PM

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
04/28/2023 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20230428140220

FACILITY NAME:	CLOISTERS OF THE VALLEY, LLC		FACILITY NUMBER:	374604267
ADMINISTRATOR:	CINDY NIEDRICH		FACILITY TYPE:	740
ADDRESS:	4171 CAMINO DEL RIO SOUTH		TELEPHONE:	(619) 283-2226
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92108
CAPACITY:	70	CENSUS: 62	DATE:	05/05/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Maintenance Director, Isaac Martinez		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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-Licensee did not allow visitation
-Licensee did not address bed bug infestation

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegations mentioned above with Business Director, Susan Dizon, Resident Services Director, River Pagala, and Maintenance Director, Isaac Martinez.

During today's visit, LPA briefly toured the facility, requested records, and interviewed staff. It was alleged the licensee did not allow visitation. Outside source interviews disclosed a resident's room had bed bugs and resident visitation was not allowed. Staff interviews revealed the residents in the infected room were isolated for fourteen (14) days. Designated staff were assigned to the room with appropriate PPE. Additional staff interviews revealed visitation was not allowed in the resident's room as a precautionary measure. However, the residents were allowed to leave the facility with visitors or visit outside. Further staff interviews revealed the residents were encouraged not to leave their room but they were not locked in their room and did in fact leave thier room at times. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

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-20230428140220

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: CLOISTERS OF THE VALLEY, LLC	FACILITY NUMBER: 374604267
	VISIT DATE: 05/05/2023

NARRATIVE

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It was also alleged, the licensee did not address a bed bug infestation. Staff interviews confirmed the infestation was being addressed. A professional pest control service was contacted and treated the infected rooms. Further staff interviews confirmed the facility was following universal precautions for bed bugs. The facility disposed of the infected furniture, bagged up clothing items along with heat treatment for clothing and appropriate cleaning for the room. The facility addressed the bed bug infestation.

Based on interviews and record review the investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Maintenance Director, Isaac Martinez whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

LIC9099 (FAS) - (06/04)

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