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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603746
Report Date: 08/23/2022
Date Signed: 08/23/2022 01:57:39 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
10/22/2021 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20211022112338
FACILITY NAME:CHHINA'S SENIOR GUEST HOUSEFACILITY NUMBER:
374603746
ADMINISTRATOR:CHHINA, JIWAN SFACILITY TYPE:
740
ADDRESS:8632 SPRING VISTA WAYTELEPHONE:
(619) 337-5201
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:6CENSUS: 5DATE:
08/23/2022
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Suki Chhina, CaregiverTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Resident was slapped by a person at the facility.
Resident is being poisoned.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close out a complaint. LPA identified herself, was granted entry, and stated the purpose of the visit to Suki Chhina, caregiver.

During the investigation, LPA toured the facility, conducted interviews and completed a records review. It was alleged that the resident was slapped by a person at the facility.

Interviews revealed staff denied slapping any of the residents. Interviews revealed staff do not physically hurt the residents. Interviews with other residents revealed they have not seen any staff slap or hit any residents. Residents interviewed denied being slapped by staff. The allegation of resident was slapped by a person at the facility is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
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 2
Control Number 08-AS-20211022112338
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: CHHINA'S SENIOR GUEST HOUSE
FACILITY NUMBER: 374603746
VISIT DATE: 08/23/2022
NARRATIVE
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It was alleged that the resident is being poisoned. Interviews revealed the staff have not poisoned any residents. interviews and observations by LPA revealed the other clients that were at the facility spoke highly of the staff and the food. Staff interviews revealed they cook a variety of foods for the residents and like to keep it different for them so they don't get tired of eating the same foods. The allegation of resident is being poisoned is unsubstantiated.

The allegations are unsubstantiated. An exit interview was conducted with Suki Chhina. A copy of this report and Licensee Appeal Rights (9058 01/16) were provided to caregiver at the conclusion of the visit.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2