374604317-9-26-2023-08-AS-DPOL-CW8VK4-20231002162942

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604317
Report Date: 09/26/2023
Date Signed: 09/26/2023 11:54:21 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
05/18/2023 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20230518111756

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: 5	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Ayad George, Administrator		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Staff speak inappropriately to visitor in the presence of resident in care
Staff speak inappropriately to resident in care
Facility phone in disrepair

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 staff speak inappropriately to visitor in the presence of residents in care. Interviews revealed that staff do not speak to visitors rudely or disrespectfully.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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-20230518111756

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: NOR LIVING 2 LLC	FACILITY NUMBER: 374604317
	VISIT DATE: 09/26/2023

NARRATIVE

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Interviews revealed that visitor in question makes disturbances and causes commotion each and every visit. Interviews revealed that in fact they observed the visitor speak inappropriately to other staff and clients. Interviews did not produce any evidence that staff speak inappropriately to visitor in the presence of residents.

It was alleged that staff 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 speak inappropriately to resident in care

It was alleged that the facility phone in disrepair. Interviews revealed the phone works properly. LPA observations revealed a working phone. Interviews did not produce any evidence to verify facility phone in disrepair

Based on the evidence obtained from interviews, and record review, the complaint allegations of staff speak inappropriately to visitor in the presence of resident in care, staff speak inappropriately to resident in care and the facility phone is in disrepair 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: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

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