374604361-2-21-2024-08-AS-RCLK-DCGV4C-20241231150606

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604361
Report Date: 02/21/2024
Date Signed: 02/21/2024 04:19:18 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
02/13/2024 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20240213152831

FACILITY NAME:	WEAVER'S PRIMROSE VILLA		FACILITY NUMBER:	374604361
ADMINISTRATOR:	GARDNER, BABETTE		FACILITY TYPE:	740
ADDRESS:	93 AVENIDA DESCANSO		TELEPHONE:	(660) 202-7741
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY:	6	CENSUS: 6	DATE:	02/21/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Rene Verceles, Caregiver		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff handled resident in a rough manner resulting in an injury
Staff makes inappropriate comments to resident
Staff did not get consent from authorized representative to feed resident solid foods
Staff does not allow residents to speak with each other

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Pena conducted a complaint investigation visit at Weaver Primrose Villa. After identifying himself, LPA was permitted into the facility. LPA met with and discussed the elements of the complaint with Rene Verceles, Caregiver. The purpose of the visit was to initiate a complaint investigation and deliver findings.

The Department's investigation included facility tour, interviews with outside sources, staff, and pertinent residents as well as review of pertinent facility records.

On 02/13/24, it was alleged staff handled Resident 1 (R1) in a rough manner, causing injury; made inappropriate comments to residents; did not obtain consent from R1’s authorized representative to feed the resident solid food and did not allow residents to speak with other residents.

LPA conducted a review of R1's records as part of this complaint investigation. R1’s records contained no

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

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-20240213152831

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: WEAVER'S PRIMROSE VILLA	FACILITY NUMBER: 374604361
	VISIT DATE: 02/21/2024

NARRATIVE

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documentation revealing a leg injury. Staff denied ever roughly handling any resident. Staff also has not witnessed any staff roughly handle any resident. Interviews with outside sources which included resident family members, did not report ever witnessing staff call residents spoiled brats or undeserving of care.
Staff and outside sources consistently reported that staff treat all residents like family and with respect.

R1’s records indicate that R1’s medical orders include notes that R1’s has been approved to eat solid foods since 2023. When interviewed, staff said they strictly follow resident’s written food orders but not verbal requests. Staff understands the liability in not following a resident’s medical provider’s orders.

Interviews indicate that no staff has ever themselves or witnessed another staff not allow residents to speak with each other. Several interviews noted that a particular resident’s family member was asked not to speak to residents that have swallowing difficulty. Staff has also asked this same family member not to discuss sensitive private matters with residents.

The Department has investigated the allegations that Weaver’s Primrose Villa staff handled R1 in a rough manner, causing injury; made inappropriate comments to residents, did not obtain consent from R1’s authorized representative to feed R1 solid food, and did not allow residents to speak with other residents. Based upon interviews and records, there is insufficient evidence to uphold any of the allegations, therefore the Preponderance of Evidence standard was not met. As such, the allegations are Unsubstantiated.

An exit interview was conducted with Caregiver, Verceles, and a copy of this report was provided to Mr. Verceles, whose signature below confirms receipt of copies of this report and Licensee Rights (LIC 9058).

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

LIC9099 (FAS) - (06/04)

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