445202559-11-12-2021-26-AS-SYIP-C9G2CM-20211206161659

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202559
Report Date: 11/12/2021
Date Signed: 11/12/2021 05:07:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/13/2020 and conducted by Evaluator Ryker Heberle

COMPLAINT CONTROL NUMBER: 26-AS-20201013153931

FACILITY NAME:	PARADISE VILLA		FACILITY NUMBER:	445202559
ADMINISTRATOR:	ERIN ROSE WILEY		FACILITY TYPE:	740
ADDRESS:	2177 17TH AVENUE		TELEPHONE:	(831) 475-1380
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95062
CAPACITY:	58	CENSUS: 29	DATE:	11/12/2021
		UNANNOUNCED	TIME BEGAN:	02:12 PM
MET WITH:	Erin Wiley		TIME COMPLETED:	05:07 PM

ALLEGATION(S):

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Illegal eviction
Facility refused to reimburse former resident's representative

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryker Heberle conducted a complaint visit today to deliver investigation findings. LPA met with Administrator Erin Wiley.

On 08/16/2020, the Department received a complaint against the facility alleging that a resident was evicted illegally, and that in the aftermath of the eviction, the facility did not properly reimburse a former resident's representative

On 10/23/2020, the Department initiated investigation of the above allegations via teleconference. During complaint opening. LPA (along with LPA Jackie Jin) obtained facility admission agreements for all residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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 26-AS-20201013153931

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: PARADISE VILLA	FACILITY NUMBER: 445202559
	VISIT DATE: 11/12/2021

NARRATIVE

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On 02/11/2021, LPAs Ryker Heberle and Marybeth Donovan visited the facility to conduct an in person investigation of the allegations. Facility Administrator (Admin) stated that no residents had not been evicted from the facility, but residents had been mutually removed due to residents needing a higher level of care. Admin did not have a written agreement or documentation indicating termination of facility services or removal for recently removed residents. Admin stated that the removal of such residents was arranged via verbal agreement.

Admin listed development of aggressive behaviors leading to injuries sustained by the facility staff as a potential reason for resident replacement. During intereview with staff, 1 out of 1 staff member stated that they had been injured by facility residents while on duty. No incident reports were submitted for staff injuries.

LPA conducted a review of resident records. No physician's reports reviewed in resident records indicated the existence of pre-existing aggressive behaviors within facility residents. Review of resident admission agreements contained facility refund policy, which stipulates "Refunds will be granted as follows: upon the death of a resident/prorated per licensing regulations." Admissions agreement also contains separate page that states "a 30 day notice must be given prior to moving out of the facility for reasons other than death; without 30 days' notice to move out, rent will not be prorated, and one full month rent will be due."

The Department has investigated the above allegations. Based on interviews conducted and records reviewed, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation did or did not occur.

Exit interview conducted with Administrator Erin Wiley. A copy of this report was provided during visit.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC9099 (FAS) - (06/04)

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