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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603746
Report Date: 08/16/2024
Date Signed: 08/16/2024 12:32:01 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
10/07/2022 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20221007143811
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:
08/16/2024
UNANNOUNCEDTIME BEGAN:
12:06 PM
MET WITH:Jiwan Chhina, AdministratorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Resident was not accorded the right to select their own health care provider.
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 Jiwan Chhina, Administrator.
During the investigation, LPA toured the facility, conducted interviews and completed a records review. It was alleged that the resident was not accorded the right to select their own health care/hospice provider. Interviews revealed that the hospital decided for Resident 1(R1) which facility to go to because they have always done business with this facility. Interviews revealed when interviewed about hospice, interviews revealed the Administrator stated “if you’re going to stay here, you have to use our hospice agency”. When asked if they would have chosen something different, Interviews revealed that they werent sure because this is their first experience with hospice. Interviews revealed they were basically propositioned to choose the facility hospice agerncy and not one of their choosing. Interviews with the staff revealed that staff stated that the hospice agency Apriva is already coming to the facility so they will be there more. Interviews with staff revealed they told the nurse that they are not choosing for the resident and that the resident would need to be the one calling hospice. Interviews revealed that R1 is alert and oriented and capable of choosing a hospice agency. Interviews revealed R1 can choose any hospice agency, that is the resident’s right. A copy of this report and Licensee Appeal Rights (9058 03/22) were provided to Jiwan Chhina, Administrator after the conclusion of the visit,
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
10/07/2022 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20221007143811

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:
08/16/2024
UNANNOUNCEDTIME BEGAN:
12:06 PM
MET WITH:Jiwan Chhina, AdministratorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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9
Resident was not accorded a reasonable level of personal privacy.
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 Jiwan Chhina, Administrator. During the investigation, LPA toured the facility, conducted interviews and completed a records review. It was alleged that the resident was not accorded a reasonable level of personal privacy. Interviews revealed this place is “squeaky clean, when they push the call button, the staff come almost immediately.” Interviews revealed they have a lot a privacy and that they have privacy when making decisions as well.

A copy of this report and Licensee Appeal Rights (9058 03/22) were provided to the Jiwan Chhina, Administrator after the conclusion of the visit, LPA Holmes requested an electronic message reply to confirm receipt of these documents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20221007143811
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CHHINA'S SENIOR GUEST HOUSE
FACILITY NUMBER: 374603746
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2024
Section Cited
CCR
87468.1(a)(1)
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Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:
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 Licensee and staff will have personal rights training by an outside source POC due to CCL by 09/06/2024. Licensee will submit sign in sheet & tranining documents by 09/06/2024
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Based on prior LPA interviews and outside witness interviews. the licensee did not ensure resident was able to make their own decision on medical provider for 1 out of 5 [R1] persons in care this poses a potential health and safety risk to residents in care.
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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: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3