374604490-2-17-2023-08-AS-SJAB-CPARAA-20230222115049

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604490
Report Date: 02/16/2023
Date Signed: 02/17/2023 10:19:26 AM

Unsubstantiated

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
01/20/2023 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20230120083046

FACILITY NAME:	COLLEGE TOWN SENIOR RETIREMENT VILLA INC		FACILITY NUMBER:	374604490
ADMINISTRATOR:	PETROSYAN, ANNA		FACILITY TYPE:	740
ADDRESS:	5252 STONE CT		TELEPHONE:	(619) 432-1236
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	6	CENSUS: 6	DATE:	02/16/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Caregiver Nvard Bedekyan		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Licensee did not allow resident(s) to attend medical appointments.
Resident(s) were not accorded dignity by staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver findings regarding the above listed complaint allegations. LPA identified herself to Caregiver Nvard Bedekyan and explained the purpose for the visit.

The department’s investigation consisted of staff and outside source interviews. The investigation also included a facility and outside source records review.

It was alleged facility staff did not allow resident(s) to attend medical appointments. An Outside Source (OS1) (See LIC 811 for Confidential Names) interview revealed Resident1 (R1) and Resident2 (R2) missed a medical appointment on January 17, 2023. OS1 also revealed a follow up call with facility Staff1 (S1) revealed the missed appointments were based on S1's decision to avoid potential exposure to COVID-19. An Outside Source3 (OS3) records review revealed R1 and R2 had missed several appointments during the months of December 2022 and January 2023. OS3 records review also revealed notations, on prior missed appointments, that the participant canceled the appointment.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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-20230120083046

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: COLLEGE TOWN SENIOR RETIREMENT VILLA INC	FACILITY NUMBER: 374604490
	VISIT DATE: 02/16/2023

NARRATIVE

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An interview with S2 corroborated S1 did not allow R1 and R2 to attend their appointment out of fear of contracting COVID-19. In contrast, additional interviews with R1 and facility Staff3 (S3) revealed R1 and R2 chose to not attend the appointment due to their recent recovering from COVID-19. An Outside Source (OS2) interview also corroborated R1 and R2 chose to decline to attend the appointment and needed more time to rest from their recent recovery.

It was also alleged residents were not treated with dignity by staff. An interview with OS1 revealed R1 and R2 were not made aware of their medical appointment, and would have wanted to attend. In interviews conducted with R1, S3, and OS2 confirmed R1 and R2 were aware, however declined to attend.

Based on interviews and records reviews conducted during the investigation regarding the above mentioned allegations were determined to be unsubstantiated. An unsubstantiated finding means although the allegations may have occurred but the preponderance of evidence standard has not been met.

An exit interview was conducted with Caregiver Nvard Bedekyan and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) will be provided. Signature of this form confirms receipt the documents were received.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC9099 (FAS) - (06/04)

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