374604267-9-10-2025-08-AS-LTEZ-DLW2TT-20250926174117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604267
Report Date: 09/10/2025
Date Signed: 09/10/2025 08:12:03 PM

Substantiated

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
09/02/2025 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20250902111313

FACILITY NAME:	CLOISTERS OF THE VALLEY, LLC		FACILITY NUMBER:	374604267
ADMINISTRATOR:	DISHA FRANCES-HALL		FACILITY TYPE:	740
ADDRESS:	4171 CAMINO DEL RIO SOUTH		TELEPHONE:	(619) 283-2226
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92108
CAPACITY:	70	CENSUS: 64	DATE:	09/10/2025
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Executive Director, Tia Suuronen-Goodwin		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff did not issue resident's responsible party a refund

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit regarding the above mentioned allegation. LPA met with Executive Director (ED), Tia Suuronen-Goodwin and Business Office Director (BOD), Susie Dizon.

During the investigation, the facility was briefly toured, records reviewed and interviews conducted with staff and outside sources. It was alleged staff did not issue resident's responsible party a refund. It was reported Resident #1 (R1) went to the hospital on 07/02/24 and did not return to the facility. On 07/16/24, R1's belongings were removed from the facility. Outside Source (OS) reported they were made aware of the refunded portion on 10/24/24 with a balance of $2649.64 and unable to obtain the refund. OS also reported the BOD wanted the balance donated back to the facility. OS interview confirmed they did not agree to donate the balance and would like their refund. LPA reviewed an email sent from the BOD to OS indicating the balance amount owed and confirming OS would like to still donate the balance to the facility. Continued on an LIC 9099C.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

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-20250902111313

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: 09/10/2025

NARRATIVE

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The Business Office Director (BOD) explained they suggested the responsible party donate the balance to the facility but it was not required. The BOD stated the facility's policy was to refund the resident or Power of Attorney (POA). R1's responsible party was not the POA. Therefore, they did not refund R1's resident's responsible party. The BOD stated in August of 2025 the facility changed their policy and is now refunding residents responsible party's if even if they are not the POA. The BOD stated they do not have anything in writing stating they can only refund the resident or the Power of Attorney. A review of R1's file reflected a credit statement owed as of 08/01/25 in the amount of $2649.64. A review of R1's Admission Agreement dated 05/03/22, indicated under the Refund Policy that if the agreement is terminated, the resident must vacate and remove their property. R1's agreement was terminated and R1's belongings were removed on 07/16/24, and no refund was issued.

The BOD also stated the refund check was approved today and awaiting corporate signatures. The Executive Director (ED) was interviewed but unable to provide facility policy details and referred LPA to the BOD. The ED was unable to provide any details regarding why R1 was not refunded once R1's belongings were removed from the facility.

Based on and interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation was found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Executive Director, Tia Suuronen-Goodwin whose signature below confirms receipt of these rights.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20250902111313

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/10/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/01/2025 Section Cited CCR 87507(f)	1 2 3 4 5 6 7	Admission Agreements. The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Executive Director agreed to refund R1's responsible party by the POC due date.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not provide a refund to 1 out of 64 [R1] residents, which posed a potential personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

LIC9099 (FAS) - (06/04)

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