374604431-11-7-2023-08-AS-DPOL-CY3286-20231129160948

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604431
Report Date: 11/07/2023
Date Signed: 11/07/2023 02:38:44 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
08/02/2023 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20230802131805

FACILITY NAME:	SENIOR LIVING NORWOODS HACIENDA III		FACILITY NUMBER:	374604431
ADMINISTRATOR:	PETROSYAN, ANNA		FACILITY TYPE:	740
ADDRESS:	9414 GROSSMONT BLVD		TELEPHONE:	(818) 284-2502
CITY:	LA MESA	STATE: CA	ZIP CODE:	91941
CAPACITY:	6	CENSUS: 4	DATE:	11/07/2023
		UNANNOUNCED	TIME BEGAN:	02:31 PM
MET WITH:	Wendy Gomez, Caregiver		TIME COMPLETED:	02:36 PM

ALLEGATION(S):

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Staff unable to communicate with residents due to language barrier

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to deliver findings. LPA was allowed entry by Wendy Gomez, Caregiver. LPA identified herself and disclosed the purpose of the visit and elements of the findings with Wendy Gomez, Caregiver

On August 2, 2023, an investigation was conducted regarding the facility staff's inability to communicate with residents due to a language barrier. The investigation confirmed that there were communication issues with staff being unable to communicate with outside sources and residents effectively in English.

During the investigation, interviews were conducted with both staff members and residents. It was found that staff members lacked proficiency in the primary language spoken by the residents. This language barrier hindered effective communication and potential neglect of residents' needs especially in the case of an emergency.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

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-20230802131805

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: SENIOR LIVING NORWOODS HACIENDA III	FACILITY NUMBER: 374604431
	VISIT DATE: 11/07/2023

NARRATIVE

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Additionally, the investigation revealed that the facility did not have adequate language support services in place to address this issue. There were no interpreters or translators available to assist with communication between staff and residents who spoke different languages. The Licensee acknowledged the language barrier and committed to addressing the language barrier issue promptly.

Based on the evidence, and interviews conducted, the preponderance of evidence standard has been met, therefore the allegation that: Staff are unable to communicate with residents due to language barrier is found to be SUBSTANTIATED.

An exit interview was conducted with Wendy Gomez, Caregiver. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to Wendy Gomez, Caregiver and her signature on this report confirms receipt of the Licensee Rights.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20230802131805

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: SENIOR LIVING NORWOODS HACIENDA III	FACILITY NUMBER: 374604431
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/07/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/07/2023 Section Cited CCR 87411(d)(3)	1 2 3 4 5 6 7	Personnel Requirements – General. All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following…Skill and knowledge required to provide necessary	1 2 3 4 5 6 7	Administrator offered to ensure that there will be at least one staff present at all times who is able to communicate in English. Administrator also offered to ensure that staff will enroll in English courses while employed by the facility. Administrator will provide a written statement to Community Care
	8 9 10 11 12 13 14	resident care and supervision, including the ability to communicate with residents. This requ't was not met as evidenced by: Based upon interviews and LPA's observation, care staff is unable to communicate with residents in care due to a language barrier. This poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14	Licensing by the POC due date of 11/14/23 that confirms this plan of action.
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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.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

LIC9099 (FAS) - (06/04)

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