Order: JEHU LOPEZ et al VS. MARC A. LEVINSON et al

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SUPERIOR COURT OF CALIFORNIA
COUNTY OF SAN FRANCISCO

Document Scanning Lead Sheet
dun-09-2009 2:37 pm

Case Number: CGC-08-475430
Filing Date: Jun-09-2009 2:35
Juke Box: 001 Image: 02520852
PETITION OF APPOINTMENT OF GUARDIAN AD LITEM

JEHU LOPEZ et al VS. MARC A. LEVINSON et ai

001002520852

Instructions:
Please place this sheet on top of the document to be scanned.$0 09 8h, 1Q 2008

Clv-010

ATTORNEY (Name, State Sar number, and address): FOR COURT USE ONLY
RAQUEL FOX, ESQ. State Bar #131675

| TENDERLOIN HOUSING CLINIC, INC.

126 Hyde Street, 2nd Floor, San Francisco, CA 94102

veLePHone No: 771-9850,ext 114 Fax No. optionoy:
E-MAIL ADDRESS /Optionaty:
ATTORNEY FOR (Name): Plaintiffs

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO

‘STREET ADDRESS:
maunc aooress: 400 McAllister Street
citvanpze cone: San Francisco, CA 94102

BRANCH NAME:

PLAINTIFF/PETITIONER: JEHU LOPEZ, et al.,
DEFENDANTIRESPONDENT: MARC A. LEVINSON, et al.,

APPLICATION AND ORDER FOR APPOINTMENT CASE Naya
FG AD LITEM_—CI
EX PARTE CGC- 48-475 430

NOTE: This form is for use in civil Proceedings in which a party is a minor, an incapacita Person, or a person for
whom a conservator has been appointed. A party who seeks the appointment of a guardian ad litem in a family law or
juvenile proceeding should use form FL-935, A party who seeks the appointment of a guardian ad litem in a probate
Proceeding should use form DE-350/GC-100. An individual cannot act as @ guardian ad|titem unless he or she is
represented by an attorney or is an attorney.

1. Applicant (name): Candelario Munoz, is
a. LZ] the parent of (name): Rudy Cartagena
the guardian of (name):
the conservator of (name):
@ party to the suit.

the minor to be represented (if the minor is 14 years of age or older).
[J another interested person (specify capacity):

pao

2. This application seeks the appointment of the following person as guardian ad litem (state name, address, and telephone number):
Candelario Munoz
30 Chumasero Drive, 6E
San Francisco, CA 94132
3. The guardian ad litem is to represent the interests of the following person (state name, address, anu telephone number):
Rudy Cartagena
50 Chumasero Drive, 6E
San Francisco, CA 94132
4,The person to be represented is:
Ra. = a minor (date of birth): July 2, 1981
b. Man incompetent person. laze CXMONT k) uv
« Ca person for whom a conservator has been appointed.
5. The court should appoint a guardian ad litem because:
a. L] the person named in item 3 has a cause or causes of action on which suit should be brought (describe):
The minor suffered injury as a result of the negligence of defendants. Thdre was a fire on May 18,
2007 that resulted in injury/damages and displacement of the minor and her family from their home
at 27 Duboce Avenue, Apartment 29A, San Francisco. Minor and her family continued displaced
due to the negligence of defendants Carlos and Dihan Suncin.

Continued on Attachment 5a.
age tof 2
Fom Adopted er ancaory Uso APPLICATION AND ORDER FOR APPOINTMENT Code of Cv Procace,
Maro tRon lamar See OF GUARDIAN AD LITEM—CIVIL Soetseg

[American LegalNet, inc,
wwe. FormeWorkiiow.comGIV-010

}— PLAINTIFF/PETITIONER: JEHU LOPEZ, et al.,
DEFENDANT/RESPONDENT: MARC A. LEVINSON, et al.,

CASE NI

Meer:

5. b. [_] more than 10 days have elapsed since the summons in the above-entitled matter was s¢
in item 3, and no application for the appointment of a guardian ad litem has been made
item 3 or any other person.

c. the person named in item 3 has no guardian or conservator of his or her estate.

d. C1 the appointment of a guardian ad litem is necessary for the following reasons (specify):

[71 Continued on Attachment 5d.

6. The proposed guardian ad litem's relationship to the person he or she will be representing is:

a. related (state relationship): -
b. [J not related (specify capacity):

7. The proposed guardian ad litem is fully competent and qualified to understand and protect the rig
represent and has no interests adverse to the interests of that person. (if there are any issues of
any possible adverse interests, describe and explain why the proposed guardian should neverthel

[1 Continued on Attachment 7.
Raquel Fox »

(TYPE OR PRINT NAME)

| deciare under penalty of perjury under the laws of the State of California that the foregoing is true a
Date: May 16, 2008

CANDELARIO MUNOZ

«TYPE OR PRINT NAME)

ved on the person named

by the person identified in

mpetency or qualification or
ss be appointed):

of the person he or she will

&

IE OF ATTORNEY)

FE OF APPLICANT)

CONSENT TO ACT AS GUARDIAN AD LITEM

| consent to the appointment as guardian ad litem under the above petition.

Date: May 16, 2008
CANDELARIO MUNOZ

(TYPE OR PRINT NAME)

= a GUARDIAN AD LITEM)

ORDER
THE COURT FINDS that it is reasonable and necessar
application, as requested.

THE COURT ORDERS that (name): CUANDELARUO MUNDO?

is hereby appointed as the guardian ad litem for (name): RUDY CARTRE:
for the reasons set forth in item 5 of the application.
ce)

Date: MUN © 5 zon5

ES] EX PARTE
ry to appoint a guardian ad litem for the person

framed in item 3 of the

OFFICER.

IGNATURE FOLLOWS LastaTTpouuent JAMES J, MCRRIDE

SUBIC
C4]
CIV-010 (Rev, January 1, 2008] APPLICATION AND ORDER FOR INTMENT
OF GUARDIAN AD LITE! IVIL

Page 2of2Serving people with developmental disabilities since 1966

September 14, 2005

Rudi Cartagena & Family
27 Duboce Avenue, #29-A
San Francisco, CA 94103

RE: CARTAGENA, Rudi - #6193439

Dear Mr. Cartagena & Family:

Enclosed is the Person-Centered Individual Program Plan| (IPP) developed

Golden Gate Regional Center

for you, if you have any questions, please phone me at (415) 54
you.

6-9222. Thank

Sincerely,
MPcicanis [it
Mark Palcanis, LCSW’
Social Worker - *ld
Enclosures
www. ggre.org
120 Howard St, 3°" Floor 3130 La Selva St, Ste 202 8725 Paradi
San Francises, CA 94105 San Mateo, CA 94403 Gorte

(415) 546-9222 (850) §74-9232 4

Dr., Bldg. A Ste 726
jadera, CA 94925
8) 945-4600*

. ~ _
PERSON-CENTERED INL. vIDUAL PROGRAM PLAN Review Date:| 7/29/2005
Page 4
Golden Gate Regional Genter
Name: Cartagena, Rudi uc # 6193439 DOB: 7/2/84

PERSONS PARTICIPATING IN. PERBON CENTERED PLANNING:

Rudi Cartagena; Fide
Lesley Steele, Janet Pi
Pomeroy Center Instru

PERSONAL PROFILE (DIAGNOSIS,

Rudi Cartagena is a 24
is a GGRC client based on havi
had the onset of diabetes this y|
attends Janet Pomeroy Center
ambulatory but has an unstead
has worn a helmet in the past.
sounds and gestures. He unde}

requires almost total assistance

PCP will be in July, 2008.

.» LEGAL STATUS;
Nonconserved adult; US |Citizen

« MEDICAID WAIVER: YES X NO

¢ MEDI-CAL, MEDICARE OR PRIVATE INSURANCE AND NUMBER:
Medi-Cal #386096 10662559

None

MEDICAID WAIVER ONLY:

DATES OF OUT-OF-STATE VISITS OF MORE THAN 7 CONSECUTIVE DAYS:

. LONG-RANGE GOALS"
1) Rudi will maintain stable health and control of diabetes. ,
2) Rudi will increase his functional skills (self care and daily living)

NewlPP
Rev 11/02

gi
He is non-verbal and communicates through

DOCUMENT ANY CHANGES IN MEDI-CAL STATUS:

mapa Munoz, Mother; Rebecca Munoz, Sister;
oe Center Supervisor; Emm

Foster, Janet

r; Mark Palcanis, GGRC Social Worker

BRIEF FUNCTIONAL DESCRIPTION OF CLIENT):

ear old Latino male of Salvadoran heritage who
ing moderate mental retardation and epilepsy. He
ar as well, He resides with his family and
in he Adult Development Program. Rudi is
ait and needs supervision to Prevent falls. He

‘stands Spanish and some English as well. He

with ail self care including toileting. His next

IF NOT ELIGIBLE FOR MEDI-CAL, EXPLAIN, IF NO APPLICA TION, EXPLAIN:

NA X_~ ~
PERSON-CENTERED INL. VIDUAL PROGRAM PLAN Reviev Date; 7/29/2005
Page 2 ,

Goiden Gate Regional Center
Name: Cartagena, Rudi icl# 6193439 DOB: 7/2/84

A. HEALTH AND WELL-BEING:

e Current Situation (include frequency and type of seizures):

Rudi has had a tough year health wise. He had the ons
January/05. His mother now checks his blood sugar with a fin
in the morning and evening. She injects him with insulin once per day. His
normal sugar reading should be in the 130-140 range and he has had good
control since the onset. He now has dietary restrictions which the day program is
aware of; ie. No sugar and low fat. Mother is also to provide a written list to the
Center.

Rudi also had gall stones removed in April/05. This affected his liver, and
he can no longer take any strong medications as a result, He rio longer takes the
medications listed in last years‘review, except Nasarel, Vasocon drops, and
Flonase as neéded for allergies and red eyes. He does have tg take the insulin.
Otherwise, Rudi still gets-frequent allergy flare ups and headaches. Rudi has a

. shunt and must be careful not to fall. He used to use a helmet but lost many of
them. He is not using one now, and staff report he can get arolind and see
better without it, however he most always has someone hold his hand for safety.

« Current Medication, Dosage and Reason Prescribed:

Insulin 20 mg. injection daily Diabetes
Nasarel 25 mg. PRN Allergies
Vasocon Eye drops, 2X per day PRN Red eyes from allergy
Flonase . §0meg, PRN Stuffy nose
¢ Date of Last Exam with Physician: 718/05,
Name: Luis A. Bonilla, MD

Phone: 285-7940
Address: 1580 Valencia St. SF, CA 94110
Specialty: General

* Date of Last Exam with Psychiatrist/Therapist: nia

Name:
Phone:
Address:
° Date of Last Exam with Dentist: 5/18/04
Name: Dr. Grimaldy, UCSF Dental

Phone: 476-1891
Address: 707 Parnassus Ave. SF, CA 94143

NewlPP
Rev 14/02~

~

‘PERSON-CENTERED INDiwiDUAL PROGRAM PLAN Review Date: | 7/29/2008

Page 3
Gaiden Gate Regional Center
Name: Cartagena, Rudi UCI#: 6193439 DOB:) 7/2/84
¢ Other Specialist: 7105
Name: St. Lukes Diabetes Clinic
Phone:

Address: 3555 Cesar Chavez St. SF, CA
Specialty: Diabetes

Special Diet / Allergies:

Rudi has seasonal allergies; he now has a strict diet geared to diabetes
control. He also has to have a low fat diet following his gall stone removal.

« Mental Health / Psychiatric Status:
No diagnosis in this area.

¢ List any Hospitalizations or Convalescent Care Stays (dates, hospital and reason):

Apri/05 St. Lukes

NewlPP
Rev 14/02

Gall stone removal~,

\ >
PERSON-CENTERED INDiviDUAL PROGRAM PLAN Review Bate:| 7/29/2005
Page 4

Goiden Gate Regional Center

Name: Cartagena, Rudi UCI#: 6193439 DOB:| 7/2184

¢ Changes in Client’s Functioning (self-care skills, behavioral, etc.)

There are no significant changes in clients functioning this year.

A. HEALTH AND WELL-BEING OBJECTIVE(S):
Ai.
health care.

Mr. Cartagena and his family want him to remain healthy and have regular

A. SUPPORTS NEEDED From Consumer, Family, Friends and Commu
A.i.a. Mrs. Munoz will schedule all medical and dental appointme

maintain contact with day program staff regaiding health cor

ni]
nf

ity:
; she will
cerns and diet.

A. SUPPORTS NEEDED From Support Service Agencies:

A.1.1. Genéral health care to be arranged with Luis A. Bonilla, MD

UCSF Dental; Medi-cal is expected to cover all funding.

and dental at

B. HOME SITUATION:

* Current issues, progress and rationale for new objectives (if in resi

include documentation that client is making progress towards the

tial placement,

Shjenthios for

which the service provider is responsible; include specifics on any eee

inadequacies and/or corrective action regarding community care fa
Rudi continues to reside with his family; mother, stepfath

ility):
r, and two

sisters Linda, 14, and Rebecca, 9. His grandmother from Et Salvador comes to

visit yearly, and this is very special to Rudi as they are close.
cleaning houses. Rudi needs assistance in all areas of self cai

rs. Munoz works
. He feeds

himself but needs supervision with this as well. He can start the toileting process

but needs assistance to complete the job. Rudi likes to help hi
cleaning up around the house, wiping the table, washing dishe:

close supervision for safety reasons at all times. Mrs. Munoz tak

since Rudi has a shunt and must avoid falls or hitting his head
loves playing the guitar and all music.

e if in residential placement, is programming appropriate? YES

family with

Ss, etc. He requires
es special care

rside. Rudi

B. HOME OBJECTIVE(S):
B.1.
assistance he needs in the home.

Mr. Cartagena wants to continue living with his family and receiving the

B. SUPPORTS NEEDED From Consumer, Family, Friends and Commu

ity:

B.1.a. Family members will provide Mr. Cartagena with assistance and supervision

for self care.

NewiPe
Rev 11/02PERSON-CENTERED INDIV UAL PROGRAM PLAN Review wate: | 7/29/2005
Page &

Gulden Gate Regional Center

Name: Cartagena, Rudi UCI#: 6193439 DOB: | 7/2/84

B. SUPPORTS NEEDED From Support Service Agencies:
8.1.1. Mrs. Munoz receives IHSS to help support her son at home.

C. WORK/DAY PROGRAM/SCHOOL:

¢ Current issues, progress and rationale for new objectives ( include
that client is making progress towards the objectives for which the
responsible):

Rudi continues at Janet Pomeroy Center 5. days per week
Development Program. He really enjoys going and the staff valu
participant. This year there has been a focus on-health concern:
the onset of diabetes and gall stone removal, both of which have
diet. The staff is aware of the diet limitations and is able to addre:
the center. Mother will maintain contact with staff regarding diet
changes or issues. She has requested that he be given a glass
half hour, and that he be taken to the bathroom on the hour. Th
worked out the previous problem of Rudi losing his jackets and h
them into his backpack when he arrives, before they can get lost,
working on table wiping, using a picture board.and book, eating
and exercise. He particularly ioves playing the guitar and other i
well as drama therapy. On Mondays, Rudi goes out on commun
group and he loves this. He needs his hand held while walking d
and balance problems. Rudi continues to thrive at JPC.

YES X NO

Is programming appropriate?

ster

cumentation

ice provider is

in the Adult

s him as a

since Rudi had

an effect on his

iss his needs at
ind any

f water every
staff has

ts; they put
Rudi is

kills, and leisure

struments, as

ity trips with his

lue to low vision

C. WORK/DAY PROGRAM/SCHOOL OBJECTIVE(S):

C.1. Mr. Cartagena indicates that he wishes to continue attending hi
at Janet Pomeroy Center five days per week.

is day program

Cc. SUPPORTS NEEDED From Consumer, Family, Friends and Community:

J

C.1.a.
- ——
CG. SUPPORTS NEEDED From Support Service Agencies:
C.1.1. Social worker requests GGRC funding of Janet Pomeroy cater — Adult
Development Program, for 23 days per month effective 9/1/05 through
8/31/08, with annual review of service and subject to the appropriation of

sufficient funds in the budget act.

NewilPP
Rey 11/02PERSON-CENTERED INDn vIDUAL PROGRAM PLAN Review Date:
Page 6

Golden Gate Regional Center

Name: Cartagena, Rudi UCI#: 6193439 DOB:

FZ 2005

72134

D. TRANSPORTATION:

° Current situation, issues, progress:

Rudi rides to program on MV Transportation. He continues to need round

trip transportation.

D. TRANSPORTATION OBJECTIVE(S):
D.1.. Mr. Cartagena wants to have round trip transportation to his qay program.

ity:

D. SUPPORTS NEEDED From Consumer, Family, Friends and Commu
| D.i.a.

D. SUPPORTS NEEDED From Support Service Agencies:

D.1.1.
month, effective 9/1/05 through 8/31/08, with annual review

Social worker requests GGRC funding of MV Transportation for 46 trips per

of service and

subject to the appropriation of sufficient funds in the budget act.

E, OTHER PROGRAMS/SERVICES/GOALS:
_(i.e. social, recreational, respite, sexuality, etc.)

® Current issues, progress and rationale for new objectives:

Rudi’s family has been receiving in home respite at the rate of 160 hours

per year. He now appears to qualify for 320 hours per year due|

monitoring of diet) and the amount of assistance and supervisio
all areas of self care, Mother also receives IHSS at 64 hours p
worker is Pedro Herrera.

of medical needs related to diabetes (checking sugar, insulin ion hee

to a combination

he requires in
r month and the

E. OTHER PROGRAMS/SERVICES/GOALS:
E4.
son’s Care.

Mrs. Munoz wants to continue receiving in home respite,to get relief from her

E.1.a.

E. SUPPORTS NEEDED From Consumer, Family, Friends and Community: |

£. SUPPORTS NEEDED From Support Service Agencies:

E.1.1. Social worker requests GGRC funding of Fiderminda Muno:
at the rate of 320 hours per year, effective 9/1/05 through 8,

budget act.

NewlPP
Rav 11/02

review of service and subject to the appropriation of sufficient funds in the

for family respite
31/08 with annual. ™ oO . ~
- PERSON-CENTERED INDIVIDUAL PROGRAM PLAN Review Data:

F281 2008
Page 7
Galden Gate Regional Center
Name: Cartagena, Rudi UCI#: 6193439 DOB:| 7/2/81
F. FAMILY ACTION PLAN

(Le. self-advocacy, rights, political action)

Current issues, progress and rationale for new objectives:

Mrs. Munoz is concerned about the services that are needed to ee her son in the
ere are no known

home. She would be willing to advocate for services when needed. TI
infringements on client's rights. a

F, FAMILY ACTION PLAN:

F.1. Client's family wants to advocate for his rights and services as needed.

J.

F. SUPPORT NEEDED From Consumer, Family, Friends and Community:
F.1.a.

F. SUPPORTS NEEDED From Support Service Agencies:

F.1.1. GGRC social worker may request family to make a call or Saf
advocate for services and/or the state budget as needed; soci
provide materials and instruction.

a letter to

ial worker will

SUMMARY OF CONTACTS SINCE LAST REVIEW:

(except for out-of-home placement where quarterly summaries have bee done)

cts.

Dates and location of face-to-face contacts with client and collateral cont

DATES LOCATION REASON PARTIGIPANTS :
7/29/05 Janet Pomeroy Cir. PCP meeting Rudi Cartagena;
Fiderminda Munoz,

Mother} Rebecca

Munoz, Sister; Lesley

Steele, JPC
Supervisor; Emma

Foster, |JPC Instructor;
Mark Palcanis, GGRC

Social Worker: Supervisor:
Mark Palcanis, LCSW Kim Zi

Dante Paden nis

dhiles

Signat 8 jaitur
ignature o gy °

NewlPP
Rev 1102

Date_~

™

PERSON-CENTERED INDIVIDUAL PROGRAM PLAN Review Date: | 7/29/2005
Page 8

Golden Gate Regional Center

Name: Cartagena, Rudi UCI#: 8193439

sree

G. FINANCIAL INFORMATION:

[ Distribution to Consumers and Conservators Only}

DOB :| 7/2/84

« Current Situation, issues, progress:

Rudi receives SSI and contributes toward the home expenses.

¢ Currently Receiving : SSI X SSA

GA

Other (specify)

e Payee: Fiderminda Munoz, Mother

‘© If GGRC is payee, current balance in GGRC Account:

¢ For Clients in residential placement: Is facility
handling monies as specified in IPP, Admission
Agreement and Title 177 YES

* Current balance of client’s P&l funds at CCF:

[G. FINANCIAL OBJECTIVE(S):
G1. none

G.tia.

G. SUPPORTS NEEDED From Support Service Agencies:
6.4.1.

G. SUPPORTS NEEDED From Consumer, Family, Friends and Community:

NewiPP
Rev 102