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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603836
Report Date: 04/19/2021
Date Signed: 04/19/2021 03:22:23 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
02/06/2020 and conducted by Evaluator Lizzette Tellez
COMPLAINT CONTROL NUMBER: 08-AS-20200206110929
FACILITY NAME:SENIORS DIGNITY HOME AND CAREFACILITY NUMBER:
374603836
ADMINISTRATOR:ALOZIE, EDWARDFACILITY TYPE:
740
ADDRESS:966 BOLLENBACHER STREETTELEPHONE:
(619) 957-6133
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:6CENSUS: 6DATE:
04/19/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Licensee/Administrator, Edward AlozieTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff yelled at resident in care
Facility staff spoke inappropriately to resident in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lizzette Tellez contacted the facility via telephone, due to COVID-19, to deliver findings for a complaint investigation. LPA identified herself and discussed the purpose of the call with Administrator, Edward Alozie.

Investigation consisted of a facility tour, interviews with staff, residents, and outside sources, and a review of records. It was alleged that Staff #1 (S1) yelled at and spoke inappropriately to Resident #1 (R1). Mr. Alozie was provided with a Confidential Names Form in order to identify S1 and R1. Investigative interviews revealed staff and outside sources have not observed S1 yell at or speak inappropriately to residents. During interview, S1 denied that they yelled at or spoke inappropriately to residents. S1 affirmed that although they have a loud speaking voice, they have no ill-intent. Interviews and LPA observation also revealed that S1 speaks with a naturally loud voice. Outside sources corroborated that there may be misinterpretations, possibly due to cultural differences. Based on interviews and observations, it was determined that there is insufficient evidence to find that staff yelled at and spoke inappropriately to a resident in care. Therefore, these allegations have been deemed unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Lizzette Tellez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021
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-20200206110929
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: SENIORS DIGNITY HOME AND CARE
FACILITY NUMBER: 374603836
VISIT DATE: 04/19/2021
NARRATIVE
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An exit interview was conducted with Mr. Alozie and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Lizzette Tellez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2