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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604317
Report Date: 02/24/2023
Date Signed: 03/03/2023 10:25:15 AM

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
07/22/2022 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20220722130024
FACILITY NAME:NOR LIVING 2 LLCFACILITY NUMBER:
374604317
ADMINISTRATOR:GEORGE, AYADFACILITY TYPE:
735
ADDRESS:1950 AVON LANETELEPHONE:
(619) 335-0566
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:6CENSUS: 6DATE:
02/24/2023
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:House Manager, Jasmin MageeTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
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9
Neglect/lack of supervision resulting in resident sustaining injury
Staff did not treat resident with dignity
INVESTIGATION FINDINGS:
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2
3
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5
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9
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13
This is an amended report to a report delivered on 2/24/2023.
Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to deliver findings. The LPA introduced himself and disclosed the purpose of the visit to House Manager, Jasmin Magee.

Throughout the investigation, the Department secured pertinent records and conducted interviews with internal and external sources.

It was alleged neglect/ lack of supervision resulted in a resident sustaining an injury. An external source reported multiple residents were witnessed to have unexplained bruises and had documented these bruises by taking photographs. Interviews with internal sources did not reveal any concerns with residents sustaining bruises in care. Interviews did reveal there had been multiple incidents involving physical altercations between residents. (See LIC 9099C for continuation of report.)
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 08-AS-20220722130024
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: NOR LIVING 2 LLC
FACILITY NUMBER: 374604317
VISIT DATE: 02/24/2023
NARRATIVE
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These incidents had not resulted in any injuries, nor bruises and did not involve the residents in question.
Interviews with external and internal sources revealed that there had been concerns in the past regarding alleged bruising, but there had been no observations of physical bruising or swelling, nor concerns raised by clients in care. Additionally, interviews with clients did not reveal concerns regarding lack of supervision. This was also corroborated after review of facility records. Additionally, an external source was not able to provide the LPA alleged photographic evidence of the bruises and swelling. These photographs were no longer available.

It was alleged staff did not treat Client #1 (C1) with dignity. It was alleged that multiple staff were witnessed calling C1 an inappropriate name. Interviews with internal and external sources, to include C1, did not reveal any concerns regarding facility staff calling clients inappropriate names, nor the clients not being treated with dignity. Based on the evidence gathered throughout the investigation, there was not a preponderance of evidence to prove the alleged violations occurred, therefore, the allegations were Unsubstantiated.

An exit interview was conducted with House Manager, Jasmin Magee, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058) were provided
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2