374602869-3-23-2023-08-AS-SJAB-CQET3S-20230330142250

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602869
Report Date: 03/22/2023
Date Signed: 03/23/2023 07:59:12 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
09/28/2022 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20220928104114

FACILITY NAME:	CEDARS @ PARADISE VILLAGE		FACILITY NUMBER:	374602869
ADMINISTRATOR:	LONG, NICOLE		FACILITY TYPE:	740
ADDRESS:	2740 E 4TH STREET		TELEPHONE:	(619) 475-5040
CITY:	NATIONAL CITY	STATE: CA	ZIP CODE:	91950
CAPACITY:	150	CENSUS: 86	DATE:	03/22/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Bill Lawson, Execuive Director		TIME COMPLETED:	02:58 PM

ALLEGATION(S):

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Facility is not following Covid 19 infection control requirements

Facility is not following Covid 19 reporting requirements

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings to the above mentioned complaint allegations. LPA Domingo identified herself and discussed the purpose of the visit with Administrator Nicole Long.

The Department’s investigation consisted of client and outside sources records review, interviews with staff and outside sources.

It was alleged that the facility was not following COVID-19 infection control and reporting requirements. Resident #1 (R1) tested positive for COVID-19 while at the hospital. Upon R1’s return to the facility an outside source #1 (OS1) reported that the facility did not inform the staff, visitors and other residents of R1’s newly diagnosed positive COVID-19 test result.

(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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-20220928104114

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: 03/22/2023

NARRATIVE

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Review of facility records revealed that the facility was following infection control requirements in regards to R1’s positive status. LPA observed personal protective equipment (PPE) being used by staff, residents and visitors. The facility continued weekly testing and screening for COVID-19 symptoms. Based on interviews with staff, residents and visitors, they were made aware of what rooms and areas that were under isolation. Review of facility records revealed that the staff was trained on infection control requirements with outside vendors. Facility documents and outside source documents revealed that the facility was reporting new cases of COVID-19 and following the facilities mitigation plan. Interviews with staff revealed that they were made aware of the residents that were diagnosed with COVID-19. The Department received documentation of staff and residents that tested positive for COVID-19. The facility also has an approved COVID-19 mitigation plan and infection control plan.

Based on records reviewed, staff interviews and outside sources interviewed, there is not a preponderance of evidence that the facility was not following Covid 19 infection control requirements and reporting requirements. Therefore, the allegations are unsubstantiated. An exit interview was conducted with the Administrator and a copy of this report, and Licensee Appeal Rights (9058 03/22) were provided to the Administrator whose signature on this form confirms receipt of these documents.

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC9099 (FAS) - (06/04)

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