374604350-5-23-2022-08-AS-DPOL-CEXVU7-20220531164415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604350
Report Date: 05/23/2022
Date Signed: 05/23/2022 05:37:10 PM

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
10/07/2021 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20211007104932

FACILITY NAME:	SUNSET COAST ASSISTED LIVING		FACILITY NUMBER:	374604350
ADMINISTRATOR:	TAPIA, PATRICIA		FACILITY TYPE:	740
ADDRESS:	1697 DONAX AVE		TELEPHONE:	(619) 882-5003
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92154
CAPACITY:	6	CENSUS: 4	DATE:	05/23/2022
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Caregiver, America Cisneros		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not meet resident's needs

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to deliver findings on the above-mentioned allegation. LPA was met by Caregiver, America Cisneros, to whom she disussed the purpose of the visit.

Investigation consisted of multiple interviews with staff, outside sources and residents, and records review, including medical records and other relevant documents pertinent to this investigation, and a tour of the facility.

On October 7, 2021, it was alleged that facility staff did not meet a resident’s needs. Details of the allegation stated that on October 3 – October 6, 2021, a resident was overheard calling out for assistance throughout the day. An outside source reported that on October 3, 2021 they visited the facility to inquire about the resident that was calling out for help; however, the resident continued to call out for help during the next few days. On October 12, 2021, four residents in care were observed at the facility. During interviews, three residents were qualified as credible witnesses. R1 was observed lying in bed in their room. R1 was talkative and was clearly heard throughout the facility. R1 had a hard time hearing and had the tendency to raise their voice when talking. R1 stated that staff help with incontinence care and expressed satisfaction with the care provided by staff. During individual interviews, R2 and R3 consistently reported that staff were very accommodating with their needs and helped with everything they needed in a timely manner.

(continued on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

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-20211007104932

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: SUNSET COAST ASSISTED LIVING	FACILITY NUMBER: 374604350
	VISIT DATE: 05/23/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Continued from LIC9099)

Both R2 and R3 consistently reported they did not recall an instance when a resident called out for help and staff did not attend to their needs. During the tour of the facility, it was observed all residents in care were clean, well-groomed, and appropriately dressed. The residents’ rooms and accommodations were observed to be clean, free from clutter and odor free. In addition, interviews with outside sources and family members reported they were not aware of any situations when staff did not attend to residents’ needs. Outside sources stated they had not witnessed or overheard any residents calling out for help during the time period in question.

During interviews with staff, it was disclosed that there was a situation when R1 became agitated and verbally loud on October 6, 2021 during attempted personal care by a new caregiver. Review of R1’s medical records disclosed that R1 had a history of refusing any physical contact including exams during medical evaluations. There was a history of R1 striking out at staff, refusing meals and medications, and not allowing personal care by staff. Outside sources did not have any concerns regarding R1’s care at the facility. Interviews with R1’s primary caregivers indicated that because R1 would only allow known caregivers provide care for them, the Administrator scheduled staff as possible to provide consistency to meet R1’s care needs.

The Department has investigated the above-mentioned allegation and has found that based upon interviews, record reviews, and observations, there was insufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, this allegation is deemed to be unsubstantiated.

An exit interview was conducted with Caregiver Cisneros and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to Ms. Cisneros at the conclusion of the visit.

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2