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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604689
Report Date: 11/19/2024
Date Signed: 11/19/2024 04:21:02 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
11/04/2024 and conducted by Evaluator Rebecca A Ruiz
COMPLAINT CONTROL NUMBER: 08-AS-20241104161351
FACILITY NAME:PARKER VILLAFACILITY NUMBER:
374604689
ADMINISTRATOR:LYNN DRUMMONNFACILITY TYPE:
740
ADDRESS:629 MICHAEL STTELEPHONE:
(619) 625-6886
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:6CENSUS: 6DATE:
11/19/2024
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Caregiver Raymond AbedozaTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Licensee did not ensure facility was staffed at night
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to conduct follow up and deliver findings regarding the above mentioned allegation. LPA was greeted by, identified herself to, and explained the purpose of the visit and the basic elements of the complaint with Caregiver Raymond Abedoza. LPA spoke with Licensee Zayden Chen and Administrator Lynn Drummond on the telephone.

During today’s visit, LPA conducted a health and safety check, observed residents in care, and interviewed residents and staff.

The Department's investigation consisted of interviews with residents and staff, record review, and a tour of the facility. It was alleged that the Licensee did not ensure the facility was staffed at night.

Continued on LIC9099-C page...
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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 4
Control Number 08-AS-20241104161351
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: PARKER VILLA
FACILITY NUMBER: 374604689
VISIT DATE: 11/19/2024
NARRATIVE
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Review of an incident report submitted by the facility to the Department on 11/18/2024 revealed that on 11/16/2024, Resident 1 (R1) left the facility on an outing. Interviews with R1 revealed that R1 told staff of R1's planned outing and staff knew that R1 would be away from the facility. Review of the incident report revealed that R1 notified Staff 1 (S1) that R1 would be returning to the facility at approximately 9:00pm. Interviews with R1 and the incident report revealed that R1 returned to the facility at approximately 9:00pm and there was no staff present at the facility to allow R1 entry into the facility. Interviews with R1 revealed that R1 attempted to get in contact with facility staff and management via telephone with no response. R1 was able to get in contact with one of the facility's management team (S2) and informed S2 that there was no one available to allow R1 entry into the facility. Interviews with R1 also revealed that R1 contacted law enforcement who arrived at the facility to assist R1. Interviews with residents and staff revealed that a staff member arrived at facility and R1 was allowed entry into the facility sometime after 10:00pm.

Review of staff schedules for November 2024 revealed that staff were assigned to work two different schedules, one from 7:00am to 6:00pm and the other from 9:00am to 8:00pm. Interviews with staff and facility management revealed that a staff member was supposed to be at the facility overnight and would get up to assist residents as needed. Those interviews also revealed that the overnight staff was not required to be awake and was not paid for the hours where staff were responsible for the overnight supervision of residents. Residents denied that staff were present at the facility overnight and stated during interviews that staff did not provide assistance to residents overnight from approximately 8:00pm in the evening to approximately 7:00am in the morning. Interviews with staff and residents revealed that there are no staff present at the facility on the weekends from approximately 8:00pm to 6:00am.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency for lack of supervision is cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page. Additionally, a civil penalty in the amount of $500 was assessed for lack of supervision and noted on the attached LIC421IM form.

An exit interview was conducted with Administrator Lynn Drummond via telephone and Caregiver Rommel Abedoza, whose signature below confirms receipt of a copy of this report, the LIC421IM, and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20241104161351
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: PARKER VILLA
FACILITY NUMBER: 374604689
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/20/2024
Section Cited
CCR
87415(a)(1)
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87415 Night Supervision (a)(1) In facilities caring for less than sixteen (16) residents, there shall be a qualified person on call on the premises.
This requirement has not been met as evidenced by:
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Administrator and Licensee understand that a staff member responsible for providing care and supervision must be present at the facility at all times when residents are also present and that the facility management is responsible for covering staff shifts if a staff calls out.
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Based on interviews and records review, the Licensee did not ensure that the facility had staff present at the facility overnight to provide care and supervision. This poses an immediate safety risk to 6 of 6 residents in care.
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Licensee will provide a signed LIC9098 stating the understanding of supervision responsibility to the Department by POC due date of 11/20/2024.
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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: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
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