374604105-9-18-2023-08-AS-SJAB-CW5MDG-20230929093103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604105
Report Date: 09/18/2023
Date Signed: 09/18/2023 11:08:56 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
07/19/2023 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20230719152301

FACILITY NAME:	RENAISSANCE LIVING II		FACILITY NUMBER:	374604105
ADMINISTRATOR:	EDWARDS, RICHARD		FACILITY TYPE:	740
ADDRESS:	12536 JACKSON HILL LN		TELEPHONE:	(619) 334-0143
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY:	6	CENSUS: 6	DATE:	09/18/2023
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Leandra Smith, Caregiver		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Resident sustained unexplained injury while in care
Staff hit residents in care
Staff is under the influence of alcohol
Staff threaten residents in care

INVESTIGATION FINDINGS:

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On 9/18/2023 at about 10:40 AM, Licensing Program Analyst (LPA), Daniel Pena, conducted an unannounced complaint visit to the facility to deliver investigative findings. After introducing and identifying himself, LPA met with Caregiver, Leandra Smith to whom LPA discussed the elements of the complaint.

On August 2, 2023, the Community Care Licensing Division (CCLD) received a complaint alleging staff caused a resident to sustain an unexplained injury requiring hospitalization; hit residents in care; worked under the influence of alcohol and threatened to call police on residents.

The Department’s investigation consisted of physical plant inspection, review of facility and resident records and interviews with residents, staff and outside sources.

The facility visit/inspection which occurred on 7/26/2023 depicted a quiet, well-lit and organized facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230719152301

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: RENAISSANCE LIVING II	FACILITY NUMBER: 374604105
	VISIT DATE: 09/18/2023

NARRATIVE

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LPA’s observations of staff and resident interactions revealed no obvious tensions between them. LPA did not observe any obvious injuries to residents.

Interviews with residents consistently stated that staff treat them well. Interviews reported that residents have not been the focus of abuse nor witnessed abuse of other residents. None of the residents had knowledge about any resident being hospitalized. No resident said they had ever seen any staff report to work under the influence of alcohol. No resident stated staff threatened to call police on them or any other residents.

Interviews with all staff produced consistent denials that they or any staff had physically abused or threatened residents in any way. Staff denied causing injury to any resident, resulting in hospitalization. The licensee was interviewed and stated that staff are lauded by residents for their manner of providing care. A review of facility records did not bring forth supporting evidence for the allegations.

The Department has investigated the allegations that staff hit and threatened residents, caused a dislocated hip injury to a resident requiring hospitalization and worked under the influence of alcohol. Due to a lack of supporting information, the Preponderance of Evidence standard was not met. Therefore, the allegations are Unsubstantiated.

An exit interview was conducted and a copy of the Licensee’s Rights (LIC 9058 3/22) along with a copy of this report was provided to Caregiver Smith.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023

LIC9099 (FAS) - (06/04)

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