374604489-4-18-2024-08-AS-LTEZ-D4U2LS-20240430173002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604489
Report Date: 04/18/2024
Date Signed: 04/18/2024 12:08:50 PM

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
08/28/2023 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20230828153715

FACILITY NAME:	AVALON PALM CARE, INC. DBA AVALON PALM		FACILITY NUMBER:	374604489
ADMINISTRATOR:	WINBLAD, JASON		FACILITY TYPE:	740
ADDRESS:	3271 INNUIT AVE		TELEPHONE:	(619) 757-3918
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92117
CAPACITY:	6	CENSUS: 6	DATE:	04/18/2024
		UNANNOUNCED	TIME BEGAN:	11:52 AM
MET WITH:	Malia Samuela, Caregiver		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Licensee did not allow resident to visit with family/friends

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced visit to deliver findings regarding the allegation mentioned above. LPA was allowed entry by Malia Samuela, Caregiver . LPA identified herself and disclosed the purpose of the visit and elements of the complaint to the Caregiver.

On August 28, 2023, a complaint was received alleging that the licensee denied a resident's right to visit with their friend. The complainant alleged that the licensee did not allow Resident 1 (R1) to visit with their family and friends. The complainant claimed that the resident's visitation rights were being denied without any valid reason.

Interviewed R1 to obtain their perspective on the visitation restrictions. Interviewed facility staff members who were involved in the decision-making process regarding visitation. Reviewed facility policies and procedures related to visitation rights. Examined any relevant documentation, such as visitation logs or incident reports.

Continued on 9099C

Unsubstantiated

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: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

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-20230828153715

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: AVALON PALM CARE, INC. DBA AVALON PALM	FACILITY NUMBER: 374604489
	VISIT DATE: 04/18/2024

NARRATIVE

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During the interview, the complainant stated that they had been denied to visit with R1 and were denied by the licensee. The complainant claimed that no valid reason was provided for the denial of visitation rights. The complainant also stated that they could visit outside of the residence on the porch.

Staff members involved in the decision-making process regarding visitation were interviewed. They explained that the visitation restrictions were implemented due to continuous disruption to other residents in care and leaving the door to R1 bedroom open with the alarm disarmed which led to the resident leaving their room and being found in the patio and or backyard of the facility. The alarm is in place to alert staff to ensure the resident's safety. However, visitation was never denied to family or friends.

Based on the investigation findings, it is concluded that the allegation of the licensee not allowing the resident to visit with their family and friends is unsubstantiated. An unsubstantiated finding means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with Malia Samuela, Caregiver . A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the 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: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

LIC9099 (FAS) - (06/04)

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