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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604117
Report Date: 04/14/2023
Date Signed: 02/02/2024 12:16:17 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/11/2023 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20230411130033
FACILITY NAME:ROSE'S CANYON VIEW ESTATEFACILITY NUMBER:
374604117
ADMINISTRATOR:PARAISO, CATHERINE TFACILITY TYPE:
740
ADDRESS:2644 CANYON RDTELEPHONE:
(760) 739-0311
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 5DATE:
04/14/2023
UNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Val Paraiso, AdministratorTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Resident wandered from the facility on more than one occasion without adequate supervision.
INVESTIGATION FINDINGS:
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On April 14, 2023, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an unannounced visit to investigate the above allegation. LPA met with Administrator, Val Paraiso who was informed of the purpose of the visit. At the time of visit, LPA Interviewed staff, reviewed resident’s file, and conducted an inspection of the facility.
Regarding the allegation “Resident wandered from the facility on more than one occasion without adequate supervision”, LPA interviewed staff who acknowledged that resident has wandered off of the facility twice but was found and was redirected back to the facility. Administrator stated staff was unaware when resident wandered off. Resident file review revealed resident has cogitative disorder. File review further revealed resident had no care plan or documentation on how to address the needs of resident. LPA inspected facility and observed facility has no safety measures in place to address wandering behaviors.
Based on LPA’s interviews, record review and facility inspection, the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division & Chapter number 6 is being cited on the attached LIC 9099D). An exit interview was conducted, and a copy of this report was reviewed with and provided along with appeal rights to Val Paraiso.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
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 18-AS-20230411130033
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ROSE'S CANYON VIEW ESTATE
FACILITY NUMBER: 374604117
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/24/2023
Section Cited
CCR
87464(f)(1)
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Basic Services;
Basic services shall at a minimum include:

(1) Care and supervision.
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Administrator stated that staff schedule will be updated to provide more covarage during the day and louder alarm will be installed to notifiy staff when a resident leaves the facility. Proof will be provided to LPA by the POC due date 4/24/2023.
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This requirement is not met based as evidence by interview, and record review. The licensee did not comply by not providing adequate supervision for resident which poses a potential health, safety or personal rights risk to persons 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: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC9099 (FAS) - (06/04)
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