374604317-3-10-2023-08-AS-JRAE-CQESYY-20230330141819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604317
Report Date: 03/10/2023
Date Signed: 03/10/2023 09:54:17 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
03/03/2023 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20230303111325

FACILITY NAME:	NOR LIVING 2 LLC		FACILITY NUMBER:	374604317
ADMINISTRATOR:	GEORGE, AYAD		FACILITY TYPE:	735
ADDRESS:	1950 AVON LANE		TELEPHONE:	(619) 335-0566
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY:	6	CENSUS: 6	DATE:	03/10/2023
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Ayad George, Administrator		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility staff are preventing resident from moving
Staff restrict resident from having visits
Staff address/speak to resident inappropriately

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Ayad George, Administrator to discuss the purpose of the visit.

LPA conducted investigation visit and was able to interview clients, facility staff, and outside sources. LPA also reviewed records, and conducted a physical inspection of the facility.

It was alleged that facility staff are preventing resident from moving. Interviews with outside source revealed Client 1 (C1) is not trying to move at this time and C1 feels they are getting all the support they need from the staff at the facility. Interviews also revealed that when C1 talks with their family they suggest moving to C1 and occasionally C1 will meniton it only when that family member is around.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

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-20230303111325

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: 03/10/2023

NARRATIVE

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Interviews with C1 revealed they are happy where they are and has not talked about moving with their case manager or the administrators of the facility. Client interviews did not produce any evidence to verify facility staff are preventing resident from moving.

It was alleged that staff restrict resident from having visits. Interviews revealed that (C1) has had visitations. Interviews revealed staff denies refusing visits to C1 or any other clients. Interviews with outside sources and facility sign in sheets revealed C1 does get visits and that the facility has not denied any visits. A record review of the facility sign in sheet for visitors showed that from December. 1, 2022 until March. 6, 2023 that C1 has had 20 visits. Client interviews revealed that they have seen C1 with visitors. Client interviews did not produce any evidence to verify that staff are not allowing visits.

It was alleged that staff address/speak to resident inappropriately. Interviews revealed that staff are respectful and kind to the clients. Interviews with an outside source also revealed that the staff are always professional and treat the clients with dignity and respect. Client interviews did not produce any evidence to verify staff address/speak to them inappropriately.

Based on the evidence obtained from interviews, and record review, the complaint allegations of facility staff are preventing resident from moving, staff restrict resident from having visits, and staff address/speak to resident inappropriately are unsubstantiated.

An exit interview was conducted with Ayad George, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

LIC9099 (FAS) - (06/04)

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