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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602869
Report Date: 10/17/2022
Date Signed: 10/17/2022 01:12:44 PM

Unfounded


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
08/31/2022 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20220831124847
FACILITY NAME:CEDARS @ PARADISE VILLAGEFACILITY NUMBER:
374602869
ADMINISTRATOR:LAWSON, WILLIAMFACILITY TYPE:
740
ADDRESS:2740 E 4TH STREETTELEPHONE:
(619) 475-5040
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:150CENSUS: 97DATE:
10/17/2022
UNANNOUNCEDTIME BEGAN:
12:07 PM
MET WITH:Executive Director Nicole LongTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Licensee employed a staff lacking criminal record clearance.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by and identified himself to Receptionist Ashley Farfan-Garcia. LPA then met with and discussed the purpose of the visit with Executive Director Nicole Long.

It was alleged licensee employed Staff #1 (S1) at the facility, despite S1 lacking the required criminal record clearance to work there. The Department’s investigation involved an unannounced facility tour, interviews of relevant staff, and a review of S1’s personnel file and CCLD’s Licensing Information System (LIS) database.

[CONTINUED ON LIC 9099-C]
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
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 5
Control Number 08-AS-20220831124847
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: 10/17/2022
NARRATIVE
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[CONTINUED FROM LIC 9099]

In their required LIC508 Criminal Record Statement, dated 06-24-2022, S1 wrote they had no criminal history. According to facility records and interviews with 2 of 2 managers, S1 underwent the Live Scan fingerprint process, then successfully obtained a criminal record clearance on 07-18-2022. This is corroborated by review of official correspondence from both the California Department of Social Services (CDSS) and the California Department of Justice (DOJ) sent to the licensee. S1 was subsequently hired by licensee on 07-25-2022 and began working.

In connection with this complaint, LPA reviewed the LIS database on 09-02-2022. LPA confirmed that even as of that date, S1 had an “Active – Working” status, with no criminal history on file, and no administrative actions against them. S1 had a valid criminal record clearance and was also correctly associated to the facility’s roster.

Based on records and interviews, the allegation that licensee employed S1 without a valid criminal record clearance is unfounded, meaning it was false, could not have happened, and/or is without a reasonable basis. We have therefore dismissed the allegation. An exit interview was conducted with Long, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
08/31/2022 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20220831124847

FACILITY NAME:CEDARS @ PARADISE VILLAGEFACILITY NUMBER:
374602869
ADMINISTRATOR:LAWSON, WILLIAMFACILITY TYPE:
740
ADDRESS:2740 E 4TH STREETTELEPHONE:
(619) 475-5040
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:150CENSUS: 97DATE:
10/17/2022
UNANNOUNCEDTIME BEGAN:
12:07 PM
MET WITH:Executive Director Nicole LongTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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-Licensee did not conduct COVID-19 Response Testing, as required.
-Facility staff did not wear facemask(s), as required.
-Facility staff did not discard used gloves in a waste receptacle, as required.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver findings regarding the above prior complaint allegations. LPA was welcomed by and identified himself to Receptionist Ashley Farfan-Garcia. LPA then met with and discussed the purpose of the visit with Executive Director Nicole Long.

It was firstly alleged that after Resident #1 (R1) became COVID-19 positive in late August 2022, licensee did not conduct the required response testing of other persons who had close contact with R1. It was secondly alleged that some facility staff did not wear their required surgical masks when on duty. It was thirdly alleged that used/soiled gloves were witnessed on the floor next to two specific trashcans (i.e. the one in the lobby and the one in the printer room nearby the lobby), indicating that staff were not discarding their gloves inside the trashcan as required. [CONTINUED ON LIC 9099-C, 1 of 2]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20220831124847
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: 10/17/2022
NARRATIVE
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[CONTINUED FROM LIC 9099] CCLD’s investigation consisted of three unannounced facility visits, interviews of relevant staff, and review of the facility’s infection control policies and training sheets, vaccination records, laboratory testing results, and contractor invoices. The Department also revisited its own database of previous COVID-19 reported cases and notes from past phone calls with the administrator on infection control.

Staff interviews and CCLD’s collected data revealed Staff #1 (S1) was the first COVID-19 positive person within the specific outbreak that is the subject of this complaint. S1 last worked at the facility on 08-21-2022, developed symptoms on 08-22-2022, and was COVID tested on 08-23-2022, with a positive result. A facility manager said S1 was interviewed as part of a CDSS-endorsed process called “contact tracing”; it revealed S1 “worked only on the facility’s 3rd floor in the 72 hours before [S1] became COVID-19 positive.” CDSS Provider Information Notice (PIN) 22-16-ASC was the testing guidance in force during the timeframe of the allegation. According to this PIN, in facilities where more than 90% of both residents and staff were fully “fully vaccinated,” and where contact tracing was feasible, licensees were authorized to limit their weekly response testing to the those who had “close contact” with the infected person, rather than response testing all staff and all residents at large. According to facility records, around 98% of its staff and 93% of its residents were “fully vaccinated” when S1 became COVID-19 positive.

Consistent with PIN guidance, licensee waited 48 hours to overcome the virus’ incubation period. Then on 08-24-2022, licensee response tested 21 residents who lived on the facility’s 3rd floor plus two staff who had contact with S1; all results returned negative. On 08-29-2022, licensee tested R1 individually, since they developed new COVID-19 symptoms; the result was positive. Licensee immediately tested R1’s spouse/roommate, Resident #2 (R2), but R2 remained asymptomatic and COVID-negative. Leveraging a nurse-staffing contractor, licensee performed its second-week response testing on 08-31-2022, expanding the sweep to 100 persons tested (going beyond “close contacts”). This time, R2 and Staff #2 (S2) were COVID-positive. On 09-07-2022, licensee used the same nurse-staffing contractor to execute a third week of response testing involving 112 persons (again going beyond “close contacts”). There were no new positive cases, and this remained true even during the next week’s response testing, effectively ending the COVID-19 outbreak. The above chronology of licensee’s response testing was corroborated by laboratory results, contractor invoices, and CDSS records.

[CONTINUED ON LIC 9099-C, 2 of 2]
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20220831124847
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: 10/17/2022
NARRATIVE
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[CONTINUED FROM LIC 9099-C, 1 of 2]

According to PIN 22-15-ASC and the California Department of Public Health order in force during the timeframe of the complaint, all facility staff were required to wear surgical facemasks when working with residents. The facility’s own internal written policy on facemasks reiterated this point and required all staff to obtain a new/clean surgical mask at the start of each shift from the facility’s lobby front desk. LPA interviewed 4 receptionists who are primarily stationed at the facility’s front desk. Each said they themselves wear a surgical mask for the duration of their shift, and that coworkers from all other job positions consistently don a surgical mask before working with residents. These observations were echoed in interviews of 2 of 2 managers. LPA visited the facility twice unannounced during late August 2022, which is the timeframe of the complaint allegation, and once unannounced in early September 2022. LPA interacted with administrative staff, culinary staff, maintenance staff, caregivers, nurses, and medication technicians. Every employee encountered was wearing a surgical mask securely over their nose and mouth.

Licensee previously filed an Infection Control Plan with CCLD and trained its staff on it. According to this plan, and consistent with regulation, used/soiled gloves must be discarded “in nearest appropriate waste receptacle with a tight fitting cover” after each task. LPA interviewed 4 receptionists and 1 manager whose workstations are very close to the two trash cans which the complainant referenced. All said they have not seen any soiled gloves on the floor either beside these trash cans or in other common areas of the facility. During LPA’s three unannounced visits, which included a tour of the facility’s medication room and walking through multiple hallways on every floor, LPA did not encounter any used/soiled gloves on the floor.

Based on interviews, record reviews, and LPA observations: A preponderance of evidence does not exist to prove that licensee fell short of COVID-19 response-testing requirements, or that facility staff did not wear their required surgical masks, or that facility staff left used/soiled gloves on the floor. The three allegations are therefore unsubstantiated. An exit interview was conducted with Long, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5