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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603836
Report Date: 12/21/2021
Date Signed: 12/31/2021 09:43:46 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
10/26/2021 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20211026124742
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: 5DATE:
12/21/2021
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Licensee Edward AlozieTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Neglect to resident resulting in unexplained injuries.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver findings regarding the above-mentioned allegations. LPA met with LIcensee Alozie identified herself, and stated the purpose of the visit.

The Department’s investigation consisted of outside source and staff interviews, and a facility tour. LPA also secured and reviewed pertinent records.

It was alleged Resident1 had unexplained injuries. A record review revealed R1 was recently admitted on On Septmeber 16, 2021, at discharge from a hospital stay, during which R1 had experienced a seizure. R1 has a diagnosis of Dementia with Delusions and an Epilepsy Disorder. Interviews with facility staff revealed, on October 23, 2021, the Administrator (S1) was in the kitchen and R1 was sitting in the chair in the living room. Due to the open layout of the house S1 had full view of R1.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
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-20211026124742
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: 12/21/2021
NARRATIVE
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R1 observed S1 begin to have a seizure and immediately fell from the chair. S1 ran to assist her and shouted for help. S2 called 911 and R1 was transferred to the Hospital and never returned. A record review revealed R1 only sustained a scalp hematoma, and was given a change in medication to reduce the potential for seizures. There was no mention of any signs of inconsistent injuries.

Staff interviews also revealed difficulty dealing with R1’s family dynamic. A record review corroborated R1 has complex social issues. Records also revealed there have been similar allegations made in the past.

Staff interviews also revealed difficulty dealing with R1’s family dynamic. A record review corroborated R1 has complex social issues. Records also revealed there have been similar allegations made in the past.
S1 ran to assist her and shouted for help. S2 called 911 and R1 was transferred to the Hospital and never returned.

Based on interviews and record reviews the finding regarding the above allegation was determined to be unsubstantiated. This finding means although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

LPA Correia conducted an exit interview with Licensee Alozie and a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) was provided to Licensee Alozie via email. An electronic email read receipt confirms the documents were received
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2