374604267-5-30-2025-08-AS-JROO-DL6TCY-20250903143732

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604267
Report Date: 05/30/2025
Date Signed: 05/30/2025 10:22:38 AM

Unsubstantiated

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
03/26/2021 and conducted by Evaluator Juliana Barfield

COMPLAINT CONTROL NUMBER: 08-AS-20210326122703

FACILITY NAME:	CLOISTERS OF THE VALLEY, LLC		FACILITY NUMBER:	374604267
ADMINISTRATOR:	KELLY, CHANNA		FACILITY TYPE:	740
ADDRESS:	4171 CAMINO DEL RIO SOUTH		TELEPHONE:	(619) 283-2226
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92108
CAPACITY:	70	CENSUS: 65	DATE:	05/30/2025
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Executive Director Tia Suuronen-Goodwin		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff did not seek timely medical care for resident.

Staff did not notice change in condition of resident.

Staff did not treat resident with dignity.

Staff did not ensure resident went to doctor appointments.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Juliana Barfield conducted a subsequent complaint visit via telephone call regarding the above-mentioned allegations. LPA was connected to, identified herself to, and discussed the purpose of the telephone call with Executive Director Tia Suuronen-Goodwin. The Department's investigation consisted of records reviews and interviews with staff and outside sources.

It was alleged that the Cloisters of the Valley (facility) staff did not seek timely medical care for Resident
one (R1). Based on record review and interviews, R1 complained of stomach pain on 12/12/20 and 12/14/20 and staff scheduled a doctor visit for 12/16/20. When R1 had stomach cramps the following week, nursing staff and former Executive Director visited R1 on the Christmas holiday. R1 complained of stomach cramps on 01/02/21 and the staff gave R1 Tylenol. R1 felt sick on 1/05/21 and facility called 911. Based on records reviews and interviews, there is not substantial evidence to support the allegation that staff did not seek timely medical care for resident, therefore this allegation is unsubstantiated.

(Continued on 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025

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-20210326122703

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: CLOISTERS OF THE VALLEY, LLC	FACILITY NUMBER: 374604267
	VISIT DATE: 05/30/2025

NARRATIVE

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It was alleged that the staff did not notice change of condition in R1. Progress notes stated R1 had stomach pain on 12/12/20, 12/14/20,12/21/20, and 01/02/21. On 01/03/21, R1 was walking and feeling good. R1 had pain on 01/05/21 and staff sent R1 to the emergency room. According to records reviews and interviews, there is not substantial evidence to support the allegation that staff did not notice a change of condition in R1, therefore the allegation is unsubstantiated.

It was alleged that staff did not treat resident with dignity. According to records reviews and interviews, R1 left the facility on 01/05/21 and did not return. R1 was enrolled with a health group that covered a seven day absence from the facility. R1 was responsible to pay for facility rent on 01/12/21 and outside source chose to move R1 out of the facility on 01/11/21. Based on records reviews and interviews, there is not substantial evidence to support the allegation that R1 was not treated with dignity, therefore this allegation is unsubstantiated.

It was also alleged that staff did not ensure resident went to doctor appointments. Records reviews and interviews indicated that R1 had doctor visits on 09/30/20, 10/15/20, 11/04/20, 11/20/20, and 12/16/20. Each of these appointments were facilitated by staff. An outside source tried to arrange an in-person appointment with R1 and two consulting doctors during Christmas week 2020. The doctors and facility had limited time, therefore the facility nurse and former executive director evaluated R1 on Christmas day. Staff noted R1 health on 01/05/21, spoke with outside source, and called 911. Based on interviews and record review , there is not substantial evidence to support the allegations that staff did not ensure resident went to doctor appointments, therefore this allegation is unsubstantiated.

 An exit interview was conducted with Tia Suuronen-Goodwin to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058 03/22) were provided. Her signature on this form acknowledges receipt of these rights.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025

LIC9099 (FAS) - (06/04)

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