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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602785
Report Date: 07/18/2024
Date Signed: 07/18/2024 11:12:28 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
06/04/2024 and conducted by Evaluator Amy Rodgers
COMPLAINT CONTROL NUMBER: 08-AS-20240604093115
FACILITY NAME:BERLAND HOME CAREFACILITY NUMBER:
374602785
ADMINISTRATOR:PARAISO, DENNISFACILITY TYPE:
740
ADDRESS:512 BERLAND WAYTELEPHONE:
(619) 205-4600
CITY:CHULA VISTASTATE: ZIP CODE:
91910
CAPACITY:6CENSUS: DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Care Giver Beth BarbaroseTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Licensee did not seek medical attention for resident.
Licensee did not meet resident's grooming needs.
Licensee did not maintain a comfortable temperature for residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced complaint investigation visit to continue investigating for the above mentioned allegations and deliver findings of the investigation. LPA gained access to the facility, identified herself, and met with Care Giver Beth Barbarose to discuss purpose of today's visit. LPA also spoke Administrator May Paraiso on the phone.

LPA's visit consisted of reviewing resident records, Observations, welfare check and delivering findings of the complaint investigation. LPA's investigation consisted of staff interviews, resident record review, observations, and outside source interviews.

Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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 2
Control Number 08-AS-20240604093115
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: BERLAND HOME CARE
FACILITY NUMBER: 374602785
VISIT DATE: 07/18/2024
NARRATIVE
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Continued from 90999

Regarding the allegation of Licensee did not meet resident's grooming needs, evidence obtained from residents Physician's Report (dated March 2023 ) indicates that Resident #1(R1) required assistance with oral care and dressing and bathing. Based on evidence obtained from R1s records, it is revealed that as part of their behavior, as a result of their medical diagnosis, consisted of resisting assistance from staff when it came to hygiene care. Interviews with outside sources confirm combative behavior when assisting R1 with ADL's.. The facility “resident Care notes” documented on numerous occasions how R1 would be aggressive and resistant to staff attempting to provide hygiene and oral care. Under regulations, residents of RCFE’s have the right to be free from “interference, coercion, discrimination, and retaliation in exercising their rights,” rights of which include “daily living functions” with the Department.

Regarding the allegation of Licensee did not maintain a comfortable temperature for residents in care. LPA observation on 6/13/2024 and on 7/18/2024 individual room temperatures in a range of 70 degrees Fahrenheit to 75 degrees Fahrenheit. Under regulations, residents of RCFE’s shall provide a comfortable temperature for residents.



Regarding the allegation Licensee did not seek medical attention for resident. Interviews with OS1 and staff reveal R1 was with outside the RCFE’s physical house when OS1 felt R1 was not responding well. Staff assisted R1 back inside facility and followed protocol for medical assistance..


Based on LPA's interviews, record reviews, and observation there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Care Giver Beth Barbarose to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
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