374600449-9-14-2023-08-AS-DPOL-CW3SVE-20230927141238

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600449
Report Date: 09/14/2023
Date Signed: 09/14/2023 10:16:41 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
08/28/2023 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230828144930

FACILITY NAME:	ST. ANTHONY'S BOARD AND CARE		FACILITY NUMBER:	374600449
ADMINISTRATOR:	BESSIE PASCUAL		FACILITY TYPE:	740
ADDRESS:	6533 PLAZA RIDGE ROAD		TELEPHONE:	(619) 470-4571
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92114
CAPACITY:	6	CENSUS: 5	DATE:	09/14/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Bessie Pascual, Administrator		TIME COMPLETED:	10:20 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Lack of supervision resulting in resident-on-resident altercation

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver findings for a complaint investigation regarding the above-mentioned allegation. 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 and records review of relevant documents pertinent to this investigation. On August 28, 2023, it was alleged that the facility staff did not provide supervision resulting in resident-on-resident altercation.

It was specifically alleged that resident #1 (R1) was pushed by resident #2 (R2). Interview with staff and Licensee said that staff had just finished providing incontinence care for another resident and needed to throw out the trash. When staff returned, they saw R2 push R1. Staff was unable to catch R1 as they were not close enough to prevent the fall. Two staff assisted R1 to a seat, and called 911 for R1 to be medically evaluated since R1 had hit their head. The ambulance arrived to take R1 to the hospital.

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: 1 of 2

Control Number 08-AS-20230828144930

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

R1 returned to the facility the following day. A review of hospital records showed that all scans returned normal. There were no acute fractures noted, and no significant soft tissue swelling was seen.

Interviews with residents confirmed that there was a staff person nearby when the incident transpired. Interviews with residents also confirmed the incident and events that occurred were due to behavioral issues. A review of records that the confirmed the staff member was working the day of the incident. Staff contacted the police and an ambulance transported R1 to the hospital and determined there were no serious injuries.

Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff and outside source interviews, and records reviewed, there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is 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) was 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 2