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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604353
Report Date: 12/20/2021
Date Signed: 12/20/2021 01:46:43 PM



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
02/23/2021 and conducted by Evaluator Carmen Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20210223113039
FACILITY NAME:MAJELLA ASSISTED LIVING, LLCFACILITY NUMBER:
374604353
ADMINISTRATOR:MORRISON, JIMFACILITY TYPE:
740
ADDRESS:2590 MAJELLA RD.TELEPHONE:
(760) 216-6344
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:12CENSUS: 10DATE:
12/20/2021
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Jim Morrison, LicenseeTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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- Licensee did not provide modified activities to residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Carmen Lopez, conducted an unannounced visit to the facility to deliver findings for a complaint investigation regarding the above-mentioned allegation. LPA Lopez identified herself and was granted entry by Karina Sanchez, Caregiver. LPA met with Jim Morrison, Licensee and stated the purpose of the visit.

The Department’s investigation consisted of, review of records including photos, and interviews with staff and residents.

On February 23, 2021, it was alleged that the Licensee was not providing residents with modified activities. Photographic evidence revealed that there was a monthly calendar posted at the entrance of the facility which allegedly staff were not adhering to. Interviews with other residents revealed that the facility was providing activities to the residents who were interested in participating in. Interviews with staff indicated that the staff did not
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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-20210223113039
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: MAJELLA ASSISTED LIVING, LLC
FACILITY NUMBER: 374604353
VISIT DATE: 12/20/2021
NARRATIVE
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always follow the planned calendar due to lack of resident participation. Staff stated they did follow the activities calendar on a monthly basis with the activities the residents enjoyed or accommodated the activity a resident was interested in. Based on records review and interviews, there was insufficient evidence to support the allegation that staff did not provide residents with modified activities.

The Department has investigated the above-mentioned allegation and based upon the evidence, it found that there is insufficient evidence to prove that the allegation occurred. Therefore, the allegation is determined to be unsubstantiated.

The report was discussed with Jim Morrison, Licensee, and a copy of this report along with Applicant/Licensee Rights (LIC9058 01/16) was provided to the Licensee via email. An electronic email receipt confirms the documents were received.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2