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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602869
Report Date: 04/27/2022
Date Signed: 04/27/2022 04:36:23 PM

Substantiated


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
03/22/2022 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20220322144630
FACILITY NAME:CEDARS @ PARADISE VILLAGEFACILITY NUMBER:
374602869
ADMINISTRATOR:NITHI NARASAPPAFACILITY TYPE:
740
ADDRESS:2740 E 4TH STREETTELEPHONE:
(619) 475-5040
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:150CENSUS: 98DATE:
04/27/2022
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator, Nithi NarasappaTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff Financially abused resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint investigation visit at the facility. LPA was greeted at the front entrance by Staff Priscilla Oseguera, and granted entry after identifying herself. LPA met with Administrator, Nithi Narasappa and explained the purpose of the visit was to deliver findings for the above allegation.

The Department’s investigation consisted of multiple interviews with facility staff, outside sources and records review, including bank statements, law enforcement reports and other relevant documents pertinent to this investigation.

On March 22, 2022, a complaint was filed with Community Care Licensing with the allegation involving financial abuse of a resident by staff member. It was reported that Staff (S1) financially abused Resident (R1) by altering a $100 check draft issued on February 13, 2022, to S1. Administrator was provided with Confidential Names Form (LIC 811) in order to identify R1 and S1. It was alleged that S1 financially abused R1 by adding zero to the amount in the line field increasing the value from $100 to $1,000.

Continued 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 08-AS-20220322144630
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: CEDARS @ PARADISE VILLAGE
FACILITY NUMBER: 374602869
VISIT DATE: 04/27/2022
NARRATIVE
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Continued from LIC9099

Per Administrator, on March 17, 2022, when R1 notified her of the alleged forgery, she immediately notified law enforcement and completed all reporting requirements to licensing and Long-Term Care Ombudsman. Administrator, Narasappa indicated that their company new hire onboarding process requires for all staff to complete trainings that specifically include a comprehensive review of personnel policies and procedures. The company personnel handbook states that it is against company policy for any employee to accept money or gifts from a resident, a family member or any other facility affiliate. In addition, Narasappa stated that S1’s position provides direct resident care to residents by bringing them meals, therefore S1 received specific trainings as a caregiver and mandated reporter requirements. LPA reviewed onboarding documents and training records and confirmed the onboarding process was completed and acknowledged by S1, which disclosed no exceptions in the hiring process. In addition, facility received background clearance for S1 prior to hiring on March 2, 2020, which indicated no prior criminal activity. Review of the Facility Resident Theft and Loss Record (LIC9060) disclosed no other loss or stolen personal property. Based on review of hiring practices, training practices and internal control systems established at the facility it appeared that this was an isolated incident that only affected R1. On April 8, 2022, S1’s employment was terminated and subsequently S1 was arrested and charged with two (2) felony charges, Penal Code 470 (D) forgery and Penal Code 368 (E) financial elder abuse by caretaker. The criminal case is pending.

Based on interviews conducted and records review there is sufficient evidence to support the allegation. The investigation findings clearly indicated that the intended amount of the check of $100 written by R1 was subsequently changed by S1 to $1,000 without R1’s knowledge nor approval. Review of security surveillance video by law enforcement confirmed S1 as the individual depositing the check issued by R1. Therefore, the allegation is deemed to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. A deficiency was cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on LIC 9099-D. A plan of corrections was developed with Administrator, Narasappa and was subsequently completed on April 13, 2022.

An exit interview was conducted with Administrator, Nithi Narasappa and a copy of this report and Licensee/Appeals Rights (LIC 9058 01/16) were provided.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20220322144630
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: CEDARS @ PARADISE VILLAGE
FACILITY NUMBER: 374602869
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2022
Section Cited
CCR
87411(a)
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Personnel Requirements - General
Facility personnel shall at all times be competent to provide the services necessary to meet resident’s needs. This requirement was not met as evidenced by:
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On April 13, 2022, Administrator conducted a facility wide in service training with all staff on company personnel policy including the prohibition of employee to accept money or gifts from a resident or family members. In addition, in service trainings were provided to all staff on mandated reporter requirements.
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Based on interviews and record review, licensee did not ensure personnel were competent, as Staff (S1) financially abused 1 of 98 residents in care. This posed a potential personal rights risk to 1 of 98 residents in care
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Tranining records will be updated on staff personnel files. POC has been completeted.
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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.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022
LIC9099 (FAS) - (06/04)
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