374604371-5-29-2024-08-AS-SJAB-D5SVVT-20240531164653

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604371
Report Date: 05/29/2024
Date Signed: 05/29/2024 01:55:04 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
04/29/2024 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20240429125831

FACILITY NAME:	LEXINGTON HOUSE		FACILITY NUMBER:	374604371
ADMINISTRATOR:	ARCELI B SONGCO		FACILITY TYPE:	740
ADDRESS:	180 W. LEXINGTON AVE.		TELEPHONE:	(619) 401-7528
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92020
CAPACITY:	6	CENSUS: 5	DATE:	05/29/2024
		UNANNOUNCED	TIME BEGAN:	12:01 PM
MET WITH:	Arceli Songco		TIME COMPLETED:	02:09 PM

ALLEGATION(S):

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Staff did not meet resident’s dietary needs
Staff did not maintain resident's hygeine
Staff did not provide resident with basic services resulting in dehydration

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano, conducted an unannounced visit to deliver complaint findings. LPA introduced himself and discussed the purpose of the visit with Administrator Arceli Songco.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of records review and interviews with facility staff and outside sources.

It was reported to CCL that facility staff were not meeting Resident 1's (R1)(an LIC 811 Confidential Names List was provided to the facility representative to identify the resident) dietary needs. Staff members and Administrator were interviewed, and it was determined that they followed the established dietary guidelines for R1 indicated in R1's medical records. Menus were appropriately adjusted based on individual needs. No evidence was found to substantiate the allegation of staff not meeting R1's dietary needs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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 08-AS-20240429125831

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LEXINGTON HOUSE	FACILITY NUMBER: 374604371
	VISIT DATE: 05/29/2024

NARRATIVE

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Staff practices related to hygiene were reviewed. It was observed that regular hygiene routines were followed, including bathing, grooming, and changing of clothes. R1 was provided with necessary supplies (e.g., toiletries, clean linens). No evidence was found to support the claim of inadequate hygiene maintenance.

LPA direct observation revealed R1 had a water bottle at R1's bedside as well as access to food and fluids. Interviews with facility staff revealed; staff members consistently provided basic services such as hydration, toileting, and assistance with daily activities to R1. The allegation of staff negligence resulting in dehydration was not substantiated. R1 was regularly offered fluids, and no patterns of neglect were identified.

LPA interviewed R1's responsible party (RP). RP expressed confidence in the facility and the facility staff. According to RP, they have had no previous issues or concerns related to the quality of care that R1 has received while at the facility. RP stated that facility staff cannot force R1 to drink fluids and when R1 is thirsty R1 will ask staff for water. RP stated that they are having some internal family issues where a certain family member wants R1 transferred to a medical facility and also wants to become R1's responsible party or power of attorney.

Records review revealed Administrator had been in regular contact with both R1's responsible party as well as outside parties that were not privy to R1's confidential medical records or information.

LPA interviewed Administrator who stated that she has been in regular contact with R1's responsible party since R1 was recently admitted to the facility. Administrator stated that R1's responsible party is happy with care that R1 has been receiving while at the facility and stated that they plan on transferring R1 back to the facility once R1 is discharged from the skilled nursing facility that R1 is currently at. Administrator stated that R1's dietary needs were met daily according to R1's physician's report. Administrator stated that although R1 was not ambulatory all of R1's hygiene needs were met, including; bathing, sponge baths, grooming, etc. Administrator stated that R1 was regularly given fluids by facility staff and dehydration was never noted on any of R1's hospital discharge documents.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240429125831

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LEXINGTON HOUSE	FACILITY NUMBER: 374604371
	VISIT DATE: 05/29/2024

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	Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid. An exit interview was conducted with Arceli Songco. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Arceli Songco whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

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