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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604317
Report Date: 05/06/2025
Date Signed: 05/06/2025 03:48:11 PM

Substantiated


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
04/18/2025 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20250418140358
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: 5DATE:
05/06/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ayad George, OperatorTIME COMPLETED:
10:05 AM
ALLEGATION(S):
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Staff are not distributing residents' medications as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to commence a Complaint Investigation regarding the above allegation. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Ayad George, Operator.

The Complainant alleged that staff are not distributing residents' medications as prescribed. CCLD’s investigation involved an unannounced facility tour, welfare check on clients, audit of medication inventory, and review of pertinent care and medication records. LPA also conducted interviewes with relevant facility staff, clients and outside sources.

[CONTINUED ON LIC 9099-C, 1 of 2]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
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 3
Control Number 08-AS-20250418140358
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: 05/06/2025
NARRATIVE
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[CONTINUED FROM LIC 9099-C, 1 of 2]

During an audit of the clients medication inventory on 04/25/2025: LPA verified that Medications were on-hand for all clients. Client 1 (C1) had an evening medication that had not been given correctly.

A review of records and interviews of staff showed that the medication was an active prescription for C1. Licensee’s staff last gave C1 their medication dose the evening on 04/20/2025. LPAs observation showed that C1 missed their medication from 4/21/2025 through 04/24/2025. (A total of 4 days) until LPA’s involvement on that day.

Per interviews with staff, they did not know why C1 had not been receiving their evening medication which was also initialized in the MARs as given. LPA observed that the medication was designed to treat Cholesterol. Interviews with outside source revealed that when C1 visits home they are given their medications that they get from the facility when C1 leaves. Interviews with C1 revealed they get their medications and when they make home visits they are given their medications from the staff and their family assists them at home with the medications.

Based on LPA observation, records, and interviews, a preponderance of evidence exists to show that staff are not distributing residents' medications as prescribed. The allegation is therefore Substantiated. A deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page).

An exit interview was conducted with Ayad George, Operator, to whom a copy of this report, the LIC 9099-D page, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20250418140358
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/09/2025
Section Cited
CCR
80075(b)
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Health Related Services: “(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.” This requirement was not met, as evidenced by:
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Licensee will continue to track all clients Medications. Licensee will provide training by an outside source for all staff regarding medication training and the MARs. POC due to CCL by POC due date of 05/9/2025
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Based on observation, records, and interviews, Licensee did not ensure that 1 of 6 clients (C1) was assisted as needed with self-administration of prescription medications, which posed a possible health risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3