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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600449
Report Date: 09/14/2023
Date Signed: 09/14/2023 09:45:47 AM

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
05/03/2023 and conducted by Evaluator Carmen Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230503131955
FACILITY NAME:ST. ANTHONY'S BOARD AND CAREFACILITY NUMBER:
374600449
ADMINISTRATOR:BESSIE PASCUALFACILITY TYPE:
740
ADDRESS:6533 PLAZA RIDGE ROADTELEPHONE:
(619) 470-4571
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:6CENSUS: 5DATE:
09/14/2023
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Bessie Pascual, AdministratorTIME COMPLETED:
09:50 AM
ALLEGATION(S):
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- Facility staff did not communicate resident's change of condition with residents responsible party
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Benachloe Sabio, caregiver. LPA stated the purpose of the visit and reviewed the findings of the complaint with administrator Bessie Pascual.

The Department’s investigation consisted of interviews with staff and outside sources, records review of relevant documents pertinent to this investigation, and LPA observation of the facility grounds. On May 3, 2023, it was alleged that the facility staff did not communicate resident’s change in condition with resident’s responsible party.

It was specifically alleged that staff did not communicate resident’s primary care physician appointments with their responsible party. Interview with the Administrator acknowledged that they did not inform the resident’s responsible party of their medical appointments. According to the Administrator, they have since been informed that they will need to notify the resident’s family about their medical appointments due to the resident being conserved.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
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 5
Control Number 08-AS-20230503131955
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: ST. ANTHONY'S BOARD AND CARE
FACILITY NUMBER: 374600449
VISIT DATE: 09/14/2023
NARRATIVE
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A review of records revealed that the facility staff will assist resident with scheduling healthcare appointments to maintain optimal health. Additional records confirmed that the resident was conserved by their family. Based on the interviews and records reviewed during the investigation there is sufficient evidence to support the allegation.

Based on the Department’s investigation there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099D.

The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Administrator Bessie Pascual. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Administrator Pascual at the conclusion of the visit. The signature below confirms the receipt of these documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20230503131955
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: ST. ANTHONY'S BOARD AND CARE
FACILITY NUMBER: 374600449
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
Section Cited
CCR
80072(a)(9)
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80072 Personal Rights (a)(9) To receive or reject medical care, or health-related services, except for minors and other residents for whom a guardian, conservator, or other legal authority has been appointed. … this requirement was not met as evidenced by:
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Administrator will obtain training from an outside service agency for residents Personal Rights and submit training certificate and/or documents to LPA by due date, 10/13/23.
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Based on interviews and records review, staff did not notify resident’s responsible party regarding their medical appointments. This posed a potential health risk to one [R1] of six residents 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: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
05/03/2023 and conducted by Evaluator Carmen Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230503131955

FACILITY NAME:ST. ANTHONY'S BOARD AND CAREFACILITY NUMBER:
374600449
ADMINISTRATOR:BESSIE PASCUALFACILITY TYPE:
740
ADDRESS:6533 PLAZA RIDGE ROADTELEPHONE:
(619) 470-4571
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:6CENSUS: 5DATE:
09/14/2023
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Bessie Pascual, AdministratorTIME COMPLETED:
09:50 AM
ALLEGATION(S):
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- Medications are not given as prescribed
- Facility did not provided activities for residents to develop their fullest potential
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Benachloe Sabio, caregiver. LPA stated the purpose of the visit and reviewed the findings of the complaint with administrator Bessie Pascual.

The Department’s investigation consisted of interviews with staff and residents, records review of relevant documents pertinent to this investigation, and LPA observations of the facility. On May 3, 2023, it was alleged that the resident’s medications were not given as prescribed; and the facility did not provide activities for residents to develop their fullest potential.

It was specifically alleged that the staff was “overmedicating” resident #1 (R1) with their medications. A review of records and medications revealed that the medications being prescribed were being appropriately administered by the facility in accordance with the resident’s medication administration record (MAR). The MAR and medications prescribed were up to date for the resident.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20230503131955
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: ST. ANTHONY'S BOARD AND CARE
FACILITY NUMBER: 374600449
VISIT DATE: 09/14/2023
NARRATIVE
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The morning medications had already been provided to the resident and their evening and bedtime medications were still intact in original packaging to be provided at the indicated timeframe. On May 10, 2023, LPA toured the facility and observed that the medications were placed in a locked and secured cabinet as required by Title 22. Based on the records reviewed and LPA observations of the medications, there is insufficient evidence to support the allegation.

It was also specifically alleged that facility did not provide activities that R1 likes, such as board games. During the initial visit on 05/10/23, LPA was able to conduct an interview with resident #2 (R2) who said that they were allowed to do the activities they wanted within reason. R2 was non-ambulatory and had the ability to go out into the community unassisted, and according to R2 she did go out into the community. While at the facility she was able to communicate with family members and had the ability to go online on social media. LPA was able to interview R1, during a collateral visit on 05/24/23 at their day program, who said that they had homework they enjoyed when they went home. Some of the activities they enjoyed at the facility was coloring. According to R1, they had many colored pencils to color with and they liked going shopping with their family. A review of records revealed that among the activities R1 enjoyed there were board games, puzzles, writing in their notebook and arts and crafts. On May 10, 2023, LPA toured the facility and observed that the facility did have board games and puzzles to provide residents with activities. Based on the interviews, records review and LPA observations, there is insufficient evidence to support the allegation.

Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff and outside source interviews, records reviewed, and LPA observations, there is not sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be unsubstantiated.

The report was discussed, and an exit interview was conducted with administrator Bessie Pascual. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to administrator Pascual at the conclusion of the visit. The signature below confirms the receipt of these documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5