374604267-10-6-2022-08-AS-LTEZ-CKKMTK-20221026095338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604267
Report Date: 10/05/2022
Date Signed: 10/06/2022 08:26:05 AM

Unfounded

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
09/28/2022 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20220928163506

FACILITY NAME:	CLOISTERS OF THE VALLEY, LLC		FACILITY NUMBER:	374604267
ADMINISTRATOR:	DELABARRE, EMILY		FACILITY TYPE:	740
ADDRESS:	4171 CAMINO DEL RIO SOUTH		TELEPHONE:	(619) 283-2226
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92108
CAPACITY:	70	CENSUS: 63	DATE:	10/05/2022
		UNANNOUNCED	TIME BEGAN:	02:02 PM
MET WITH:	Administrator, Emily DeLaBarre		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

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Illegal Eviction

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 allegation mentioned above with Administrator, Emily DeLaBarre and Executive Director, Channa Kelly .

During today's visit, LPA briefly toured the facility, requested records, and interviewed staff. It was alleged Resident #1 (R1) was being illegally evicted. R1's Physician's Report indicated R1 has been sent out from the facility to the hospital three times, due to a higher level of care needed for R1's medical condition. R1 is currently receiving care at a Skilled Nursing Facility (SNF). It was reported the facility will not accept R1 back to the facility upon discharge from the SNF. The Physician's Report also indicated R1's medical condition cannot be cared for at an Assisted Living Facility (ALF) due to the complex level of care that is required. Administrator's interview revealed a meeting was held with necessary parties making them aware R1 was not being evicted but does require a higher level of care due to a change in condition. The facility's mobile physician documented R1 requires a higher level of care that exceeds what can be provided at an ALF. Continued on an LIC 9099C.

Unfounded

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: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

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-20220928163506

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: 10/05/2022

NARRATIVE

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The administrator stated they are aware R1 requires a higher level of care. However, they will accept R1 back and proceed with meeting R1's needs. Facility's documentation of communication with outside source confirmed the facility was not evicting R1 and there was a misunderstanding. Further staff interviews revealed R1 is allowed to return to the facility once discharged from the SNF. Outside source interviews revealed R1 and/or R1's responsible party was not provided with a verbal or written notice of eviction. Administrator confirmed neither a verbal or written notice of eviction was provided to R1 and/or R1's responsible party. R1 was not illegally evicted as R1 was not given a verbal or written notice of eviction.

Based on interviews and record review, this agency has investigated the complaint alleging an illegal eviction. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Administrator, Emily DeLaBarre 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: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

LIC9099 (FAS) - (06/04)

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