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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603451
Report Date: 03/28/2025
Date Signed: 03/28/2025 02:00:05 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/19/2025 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20250319111801
FACILITY NAME:ESCONDIDO SENIOR LIVINGFACILITY NUMBER:
374603451
ADMINISTRATOR:SHAUN MCGUIRKFACILITY TYPE:
740
ADDRESS:1351 E WASHINGTON AVETELEPHONE:
(760) 741-3055
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY:143CENSUS: 117DATE:
03/28/2025
UNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Jessica Playa, Executive DirectorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to commence a complaint investigation for the allegation listed above. LPA met with Jessica Playa, Executive Director and explained the purpose of the visit and the elements of the allegation. The allegation was investigated, and the investigation consisted of observations, interviews and records review.

On 03/19/25 Community Care Licensing received a complaint alleging that staff did not safeguard resident's personal belongings. It was alleged that on or around January 25, 2025 Resident #1 (R1)s dentures were lost as they could not be located in R1s room, or on their person. It was further alleged that the dentures were lost by a facility staff, and that the dentures would be replaced, and to provide the bill. Per an interview with Resident Care Coordinator Shawna Emery it is believed that the dentures may have accidentally been thrown inside the trash by one of the facility staff, as the dentures were allegedly placed inside a popcorn bag. Per Shawna the trash receptacles were searched but nothing was found. LPA conducted additional interviews that corroborated that previous administration did state that the facility would replace the lost
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
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 18-AS-20250319111801
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ESCONDIDO SENIOR LIVING
FACILITY NUMBER: 374603451
VISIT DATE: 03/28/2025
NARRATIVE
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dentures, if the dentures were lost by one of the facility staff. Per an interview with Executive Director Jessica Playa and Shawna Emery, Resident Care Coordinator Staff #1 (S1) admitted that they may have misplaced R1s dentures.

Additionally, LPA conducted a records review and the resident handbook states "we cannot be responsible for any items brought into the facility that is not listed on the resident personal property and values form". LPA reviewed R1s personal property and values sheet dated 9/22/24, and it does note for R1 to have partial dentures. Further LPA reviewed correspondence an email dated 2/12/25 which included an invoice stating the replacement dentures would cost $4,480.00. The next email reviewed dated 2/19/25 shows that the facility was going to conduct an internal investigation, and there is no further written correspondence to date in regards to the matter.

Based on observation, interview and records review the allegation of Staff did not safeguard resident's personal belongings is substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. A citation will be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted and a copy of this report, 9099D, appeal rights and LIC811-Confidential names list was reviewed and provided to Jessica Playa, Executive Director.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20250319111801
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ESCONDIDO SENIOR LIVING
FACILITY NUMBER: 374603451
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/11/2025
Section Cited
CCR
87218(a)(2)
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87218 (a)The licensee shall ensure an adequate theft and loss program as specified in H&S code 1569.153. (2) A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property at its current value. The Licensee shall be
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The licensee agrees to replace in the form of a credit to R1s account for the amount of the dentures quoted on bill provided on 2/12/25 for $4,480.00 Proof of POC is to be submitted to the department by 5pm on the due date (4/11/25) indicated.
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resumed to have made reasonable efforts to safeguard resident property if there is clear and convincing evidence of efforts....This requirement is not met as evidenced by: R1 dentures being lost by facility staff. This poses a potential health, safety and personal rights risk to persons 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: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
LIC9099 (FAS) - (06/04)
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