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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603136
Report Date: 07/15/2025
Date Signed: 07/15/2025 02:10:39 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
04/18/2025 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20250418130533
FACILITY NAME:CORONADO RETIREMENT VILLAGEFACILITY NUMBER:
374603136
ADMINISTRATOR:ELIZABETH REYESFACILITY TYPE:
740
ADDRESS:299 PROSPECT PLACETELEPHONE:
(619) 437-1777
CITY:CORONADOSTATE: CAZIP CODE:
92118
CAPACITY:120CENSUS: 74DATE:
07/15/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Executive Director, Rajni KharbandaTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff did not give medication as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the complaint investigation regarding the above mentioned allegation. LPA met with Wellness Director, Camille Nero. Executive Director, Rajni Kharbanda arrived during the visit.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, resident, and outside sources. It was alleged staff did not give medication as prescribed. It was reported Resident #1 (R1) had a PRN order on file for Desitin paste to be applied for skin irritation. Outside source #1's (OS1) interview revealed on 04/15/25, R1 complained of pain twice in the same day and the Desitin was brought to R1 but not applied. An interview with a Medication Technician (med tech) stated only the med tech's are allowed to administer the cream. Another med tech stated that the med tech dispenses the cream into a cup and the caregivers apply the cream. Staff interviews revealed conflicting statements. Caregivers stated they report the PRN is needed to the med tech and it's applied by the med tech. Continued on an LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
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 3
Control Number 08-AS-20250418130533
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: CORONADO RETIREMENT VILLAGE
FACILITY NUMBER: 374603136
VISIT DATE: 07/15/2025
NARRATIVE
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Caregivers also stated if they already have their gloves on they will apply the cream, once brought by the med tech. Staff also reported R1 is verbal and expresses any concerns to them. The Wellness Director explained when there's a PRN medication, the resident will verbalize their need and the med tech will administer the PRN and document it. A review of the Medication Administration Record indicated the Desitin was not dispensed on 04/15/25, when requested. The Executive Director explained the med tech's follow the orders and they are the only one's to apply creams. However, some caregivers are cross trained on administering medications/creams. R1's interview confirmed they asked for the Desitin twice on 04/15/25 due to pain. R1 also stated the med tech brought the cream in a little cup but did not administer it.

Based on interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation was found to be substantiated. California code of Regulations,(Title 22, Division 6 & Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Executive Director, Rajni Kharbanda whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20250418130533
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: CORONADO RETIREMENT VILLAGE
FACILITY NUMBER: 374603136
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2025
Section Cited
CCR
87465(c)(2)
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Incidental Medical and Dental Care. If the resident's physician has stated in writing...need for nonprescription PRN medication...shall be permitted to assist the resident...are met: Once ordered by the physician the medication is given according to the physician's directions.
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Executive Director stated they will have In-Service training on medications and provide proof of training by POC due date.
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This requirement is not met as evidenced by:
Based on interviews and record review the licensee did not give Desitin paste as prescribed for 1 out of 74 [R1] residents, which posed a potential health and safety risk to 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: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3