374604267-3-15-2024-08-AS-SJAB-D3QK4S-20240326073450

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604267
Report Date: 03/15/2024
Date Signed: 03/15/2024 05:09:18 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
03/08/2024 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20240308090955

FACILITY NAME:	CLOISTERS OF THE VALLEY, LLC		FACILITY NUMBER:	374604267
ADMINISTRATOR:	DISHA FRANCES-HALL		FACILITY TYPE:	740
ADDRESS:	4171 CAMINO DEL RIO SOUTH		TELEPHONE:	(619) 283-2226
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92108
CAPACITY:	70	CENSUS: 65	DATE:	03/15/2024
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Chad Coleman, Executive Director of Operation		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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-Unlawful eviction
-Facility did not safeguard resident’s belongings
-Facility did not respond to communications from resident’s authorized representative

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Daniel Pena, conducted an unannounced visit to the facility to initiate a complaint investigation. After introducing and identifying himself, LPA met with Executive Director of Operations, Chad Coleman, and discussed the elements of the complaint.

On 03/08/2024, the Department received the following allegations: unlawful eviction of resident, facility did not safeguard a resident’s belongings, and the facility did not respond to communications with a resident’s authorized representative. The Department’s investigation consisted of record reviews, and interviews with facility staff and outside sources.

Per facility records, Resident 1 (R1) was admitted to the facility on 12/10/2019. LPA reviewed the Facility Residence and Care Agreement (admission agreement). LPA observed R1’s electronic signature throughout the agreement. LPA also observed a section of the document titled, “Appendix J, Eviction Procedures, 22 CCR 87224(a).” R1’s electronic signature was entered on this section on 12/9/2019. The page reads in part, “the licensee may, upon thirty (30) days written notice to the resident, evict the

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024

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-20240308090955

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CLOISTERS OF THE VALLEY, LLC	FACILITY NUMBER: 374604267
	VISIT DATE: 03/15/2024

NARRATIVE

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resident for one or more of the following reasons: (1) Nonpayment of the rate for basic services within ten days of the due date.”

Interviews with outside sources revealed that R1 had been receiving Medi-Cal funding when they first were admitted to the facility in 2019. This funding paid for R1’s rent at the facility. Outside sources stated that R1 never had to reapply for the funding. However, in early 2024, R1’s Med-Cal coverage stopped and R1 was required to reapply. This caused an interruption of R1’s funding source to pay the required rent payment. In February and March 2024, the facility issued 30-day notices of eviction to R1 due to the lapse of coverage and R1’s outstanding balance due. Interviews with outside sources do not dispute this fact.

On or about September 2023, R1’s fanny pack, containing their identification card, credit cards and insurance cards were reported missing by R1’s authorized representative. According to interviews with an outside source, $60.00 cash was also missing. Interviews with outside sources and staff revealed that R1’s fanny pack along with their missing cards were found and returned to R1. The $60.00 cash was not found. On 12/9/2019, R1 electronically signed the admission agreement which reads in part, “IX. Your Property Rights and Obligations C. Damage to your Property. We shall not be responsible for the loss of any personal property belonging to you due to theft, fire or any other cause, unless the loss or damage was caused by our negligence or that of our employees.” This allegation nor the fruits of interviews conducted during this investigation yielded information or evidence to indicate employees or negligence contributed to the alleged loss.

As to the allegation, the facility did not respond to communications from R1’s authorized representative, LPA found the following. Facility records, including emails and progress notes, provided substantial documentation to dispute the allegation. LPA observed numerous emails and progress notes generated by staff and directed to outside sources representing R1. An outside source provided a conflicting assessment of this allegation. The outside sources stated that the facility communicated with this party as requested and experienced no problems.

The Department has investigated this complaint. Based upon records reviewed and interviews with staff and outside sources, there is insufficient information to corroborate the allegations. The preponderance of evidence standard was not met. The allegations are deemed unsubstantiated.

An exit interview was conducted and a copy of Licensee's Rights (LIC 9058 3/22) along with a copy of this report was provided to Director, Coleman.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024

LIC9099 (FAS) - (06/04)

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