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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604171
Report Date: 04/07/2023
Date Signed: 04/07/2023 11:36:52 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/19/2022 and conducted by Evaluator Iby Strong
COMPLAINT CONTROL NUMBER: 08-AS-20221219104810
FACILITY NAME:LO-HAR SENIOR LIVINGFACILITY NUMBER:
374604171
ADMINISTRATOR:DUCHARME-FRANKLIN, KANDYFACILITY TYPE:
740
ADDRESS:768 DOROTHY STTELEPHONE:
(619) 444-8270
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:68CENSUS: 56DATE:
04/07/2023
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Administrator Kandy FranklinTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Neglect/Lack of Supervision resulted in injury
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings in the above complaint allegation. LPA identified herself and discussed the purpose of the visit with Administrator Kandy Franklin.

On December 19, 2022, Community Care Licensing (CCL) received a complaint alleging neglect/lack of supervision resulted in injury to Resident 1 (R1).

During investigation, LPA Strong collected pertinent resident records as well as facility documentation and conducted interviews. Based on Resident 1 (R1) Physician’s Report dated July 7, 2022, R1 is diagnosed with mild cognitive impairment, is confused and disoriented, does not require continuous care, can leave facility unassisted, and has a wandering behavior. R1’s Individual Care Plan signed March 28, 2022, revealed R1 is independent with toileting and eating, and is forgetful.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023
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-20221219104810
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: LO-HAR SENIOR LIVING
FACILITY NUMBER: 374604171
VISIT DATE: 04/07/2023
NARRATIVE
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According to allegation, on December 17, 2022, R1 wandered away from facility which resulted in R1 falling and sustaining an undescribed injury. During interview with Administrator, it was revealed that R1 was moved into memory care cottage due to a change in medical condition as of June of 2022. Administrator revealed that R1 does not have a diagnosis of major neuro cognitive impairment. According to interview with staff present on the date of the incident, R1 was last seen during shift change at on or around 1:30pm in the gated outdoor area. Interview with staff established that R1 was not found during dinner service at on or around 5:30pm and staff initiated a search for R1. Interviews revealed that emergency personnel arrived at facility to collect a report on the same day of incident. Interview with Administrator revealed R1 was kept at hospital for observation and treated for a skin tear on the knee and minor bruising to the hands, as well as a possible infection.

Based on LPA's interviews with staff, outside source interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Administrator Kandy Franklin, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2