374604540-5-6-2025-08-AS-SJAB-DGMLST-20250513090113

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604540
Report Date: 05/06/2025
Date Signed: 05/06/2025 02:28:01 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
04/18/2025 and conducted by Evaluator Angelica Boyles

COMPLAINT CONTROL NUMBER: 08-AS-20250418110207

FACILITY NAME:	NOR LIVING 5 LLC		FACILITY NUMBER:	374604540
ADMINISTRATOR:	RZOK, NAJAH J.		FACILITY TYPE:	735
ADDRESS:	2037 SIEGLE DRIVE		TELEPHONE:	(619) 335-0566
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	6	CENSUS: 5	DATE:	05/06/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	House Manager Kevin Jones		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Licensee did not give resident(s) medication as prescribed
Medication errors

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegations. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with House Manager Kevin Jones.

The Complainant alleged that Licensee did not give clients medication as prescribed and there being medication errors.

CCLD’s investigation involved multiple unannounced facility tours/welfare checks, interviews of clients in care, and interviews of facility staff and outside sources. The Department also reviewed the LIC602 Physician’s Reports, lists of prescribed medications, and Medication Administration Records (MARs) for all clients.

[CONTINUED ON LIC 9099]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
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)

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Control Number 08-AS-20250418110207

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 5 LLC	FACILITY NUMBER: 374604540
	VISIT DATE: 05/06/2025

NARRATIVE

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[CONTINUED FROM LIC 9099]

LPA observed the facility’s locked medication cabinet which was well organized. All five (5) clients in care were alert, and activel; none appeared drowsy or sedated. The clients’ MARs contained timely and consistent staff initials and documentation.

Interviews of clients, staff, and outside sources corroborated that there were no known recent medication errors at the facility, nor a pattern of medication errors when looking further back in time. Per LPA’s review of CCLD’s Incident Report database, Licensee had no self-reported medication errors over the last year.

All direct care staff that LPA interviewed attested that they underwent formal academic and hands-on training on medication assistance. They were also able to correctly recite the “Seven Rights of Medication Administration,” from memory.

Based on records and interviews, a preponderance of evidence is not met to show that Licensee did not give clients medication as prescribed and there being medication errors. These allegations are therefore Unsubstantiated, and no deficiencies cited.

An exit interview was conducted with House Manager Kevin Jones, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
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)

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