374604323-3-30-2023-08-AS-DPOL-CQET6F-20230330142704

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604323
Report Date: 03/30/2023
Date Signed: 03/30/2023 09:25:07 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
01/19/2022 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20220119130124

FACILITY NAME:	SILVERGATE RANCHO BERNARDO		FACILITY NUMBER:	374604323
ADMINISTRATOR:	BRAKEVILLE, SONDRA		FACILITY TYPE:	740
ADDRESS:	16061 AVENIDA VENUSTO		TELEPHONE:	(858) 451-1100
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92128
CAPACITY:	285	CENSUS: 220	DATE:	03/30/2023
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Maureen Manzon, Assistant Director of Resident Care, and Severino Doria, Director of Resident Care		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

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- Resident care needs are not being met.
- Resident is not given privacy.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver findings for an opened complaint investigation. While at the facility LPA delivered findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Mary Polak, Receptionist. LPA stated the purpose of the visit and reviewed the findings of the complaint with Maureen Manzon, Assistant Director of Resident Care, and Severino Doria, Director of Resident Care.

The Department’s investigation consisted of interviews with staff and outside source, records review of relevant documents pertinent to this investigation. On January 19, 2022, it was alleged that resident care needs were not being met. It was also alleged that a resident was not given privacy. It was specifically alleged that the staff locked the resident’s bathroom and was not allowed to utilize the bathroom.

Interview with staff said, in the memory care unit, all residents had a commode in their rooms, especially during a COVID-19 outbreak. During the pandemic, when one of two residents who shared a bathroom, tested COVID-19 positive, the positive resident would use their commode.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20220119130124

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: SILVERGATE RANCHO BERNARDO	FACILITY NUMBER: 374604323
	VISIT DATE: 03/30/2023

NARRATIVE

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According to staff, if a resident opted to use the bathroom, the resident would need to call staff to assist them. This would give staff an opportunity to assist the resident and subsequently sanitize the bathroom. During the initial visit, LPA spoke with Executive Brakeville who confirmed that the shared bathroom door was locked due to facility implementing infection control protocols. According to records from 1/14/22 to 1/21/22, a resident’s bathroom was locked for approximately seven days. There were explicit instructions that care staff were to escort the resident to use the sink and for staff to empty the commode frequently. Records showed that the bathroom was shared between two residents. Protocols were enacted to ensure the virus would not spread and it would remain contained in an isolated area. Based on the information contained during the investigation, there is insufficient evidence to substantiate the allegation.

On January 5, 2023, it was specifically alleged that a resident would often enter into another resident’s room. Interviews with staff said there were times in the memory care unit that residents would accidentally go into another resident’s room because they were confused or forgetful, but staff would redirect those residents. Staff were unable to recall specific names or dates of the occurrences which were common due to resident’s cognitive status. According to staff, this was common in the memory care unit, nonetheless staff were able to redirect the residents out of the room. If the family had concerns, the facility attempted to accommodate both the resident and the families. There were times that residents would be moved to another room at the family’s request. Although there were residents who would unintentionally enter another resident living quarters, staff undertook measures to ensure residents were redirected and provided closer monitoring. Based on the information obtained, there is insufficient evidence substantiate the allegation.

Based on the Department’s investigation of the above-mentioned allegations there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be unsubstantiated.

The report was discussed, and an exit interview was conducted with Maureen Manzon, Assistant Director of Resident Care, and Severino Doria, Director of Resident Care. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Director of Resident Care Doria at the conclusion of the visit. The signature below confirms the receipt of these documents.

SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC9099 (FAS) - (06/04)

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