374604267-6-13-2024-08-AS-SJAB-D6FP5Q-20240621110106

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604267
Report Date: 06/13/2024
Date Signed: 06/13/2024 04:36:17 PM

Unfounded

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
06/04/2024 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20240604153214

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: 64	DATE:	06/13/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Tia Suuronen-Goodwin, Executive Director		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Licensee did not provide resident or their representative a comprehensive description and fee schedule for services, as per the admission agreement

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced visit to initiate a complaint investigation. LPA introduced himself and disclosed the purpose of the visit to Tia Suuronen-Goodwin, Executive Director. Upon completion of the visit and investigation, LPA delivered to Director Suuronen-Goodwin, the findings.

On June, 4, 2024, CCLD received this complaint. It was alleged the Licensee did not provide Resident 1 (R1) or their representative a comprehensive description and fee schedule for services, as per the admission agreement.

The Department’s investigation consisted of an unannounced facility visit, review of facility and resident records, and interviews with facility staff and outside sources. Staff interviews and record reviews provide evidence that the licensee transmitted, via electronic messaging, transaction records which listed the outstanding fees for R1’s care and services.

(CONTINUED ON LIC9099-C)

Unfounded

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: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

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-20240604153214

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: 06/13/2024

NARRATIVE

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Record reviews revealed that the fees for rent and services were recorded in R1’s Admission Agreement. LPAs review of the agreement, indicates that R1's rent and services have not increased and remained consistent with the terms set forth in the contract.

Review of the signed Admission Agreement, transaction records, and documented communication between R1’s representative and the Licensee confirms that the Licensee provided billing records that lists the amount being charged to R1. The fees are consistent with the terms and amount agreed upon by the Licensee and R1’s representative.

Based on record review and interviews, the allegation that "the Licensee did not provide R1 or their representative a comprehensive description and fee schedule for services, as per the admission agreement" is UNFOUNDED, meaning it was false, could not have happened, and/or is without a reasonable basis.

The allegation has therefore been dismissed. An exit interview was conducted with Tia Suuronen-Goodwin, Executive Director, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

LIC9099 (FAS) - (06/04)

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