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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604407
Report Date: 03/24/2025
Date Signed: 03/24/2025 02:30:25 PM

Substantiated


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
08/02/2021 and conducted by Evaluator Becky Kennedy
COMPLAINT CONTROL NUMBER: 08-AS-20210802083301
FACILITY NAME:BAYSHIRE CARLSBADFACILITY NUMBER:
374604407
ADMINISTRATOR:HIGHTOWER, SASHAFACILITY TYPE:
741
ADDRESS:3140 EL CAMINO REALTELEPHONE:
(760) 720-9898
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:125CENSUS: 115DATE:
03/24/2025
UNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Pam Talamantes, Resident Services DirectoTIME COMPLETED:
02:32 PM
ALLEGATION(S):
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Staff administered medications to resident not prescribed by a physician.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Becky Kennedy conducted an unannounced complaint investigation visit to the facility to deliver findings on the above allegation. LPA was granted entry to the facility and met with Pam Talamantes, Resident Services Director LPA identified herself and explained the reason for the visit.

It was alleged that facility staff administered medications to a resident not prescribed by a physician.
The Department’s investigation consisted of review of facility records, interviews with internal and outside sources, and a tour of the facility.

The investigation revealed that on 7-30-2021, Resident 1(R1) (see LIC 811 for a list of confidential names.) was asked by facility staff member 1 (S1) who was recently hired and in training if R1 was Resident 2 (R2) using R2’s name and room number. R1 answered “yes”. S1 gave the medication prescribed for R2 to R1.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025
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-20210802083301
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: BAYSHIRE CARLSBAD
FACILITY NUMBER: 374604407
VISIT DATE: 03/24/2025
NARRATIVE
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The facility immediately notified R1’s family and physician regarding the error upon discovery. R1 was sent to the hospital for observation. There were no adverse consequences to R1.

Based on the evidence obtained during the complaint investigation, the allegation above are SUBSTANTIATED, meaning there is a preponderance of evidence to prove a violation occurred.
An exit interview was conducted with Pam Talamantes, Resident Services Director a copy of this report and Licensee's Rights (LIC9058) were provided.
SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20210802083301
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: BAYSHIRE CARLSBAD
FACILITY NUMBER: 374604407
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/26/2025
Section Cited
CCR
87028(a)
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Plan of Operation. The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so.
This requirement was not met as evidenced by:
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The facility will hold a training for medtechs regarding Medication Rights and Resident identifiers.
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Based on interviews and a record review, licensee did not operate in accordance with the facility’s Program Design by medication staff giving a resident’s medication to another resident, (1 of 114). This posed potential health and to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3