<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602869
Report Date: 04/03/2023
Date Signed: 04/03/2023 02:37:21 PM

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
06/18/2020 and conducted by Evaluator Rebecca A Ruiz
COMPLAINT CONTROL NUMBER: 08-AS-20200618160126
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: 91DATE:
04/03/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Senior Executive Director Bill LawsonTIME COMPLETED:
02:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not treat resident with dignity
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to conduct follow-up and deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Senior Executive Director Bill Lawson. LPA also met with Resident Care Coordinator Sheryll Chicano.

During today's visit, LPA toured the facility and interviewed staff and residents.

The Department’s investigation consisted of interviews with residents and staff, records review, and a tour of the facility. It was alleged that facility staff did not treat resident with dignity. Interviews revealed that Resident 1 (R1) required assistance with bathing. In June 2020, Staff 1 (S1) assisted R1 during a shower and R1 believed that S1 had unintentionally treated them roughly.

Continued on LIC9099-C page...
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023
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 2
Control Number 08-AS-20200618160126
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: 04/03/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 Interviews revealed that R1 had a medical condition and a recent medical procedure which caused R1 to have a sore and stiff arm. Interviews revealed that R1 did not inform S1 of R1’s sore arm and did not ask S1 to be gentler when showering R1. Interviews with staff and residents did not support any evidence or concerns of rough treatment of residents during showers. The Department was unable to interview S1.

The Department has investigated the above-mentioned allegation and based on interviews, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Senior Executive Director Bill Lawson, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2