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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604407
Report Date: 04/15/2025
Date Signed: 04/15/2025 04:14:23 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
12/06/2024 and conducted by Evaluator Hannah Rodgers
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20241206105851
FACILITY NAME:BAYSHIRE CARLSBADFACILITY NUMBER:
374604407
ADMINISTRATOR:CHAD COLEMANFACILITY TYPE:
741
ADDRESS:3140 EL CAMINO REALTELEPHONE:
(760) 720-9898
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:125CENSUS: 108DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Resident Services Director Pamela TalamantesTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Staff handled resident in a rough manner resulting in injury
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced themselves and disclosed the purpose of the visit to Resident Services Director Pamela Talamantes.

On December 6, 2024, it was alleged that the staff handled resident in a rough manner resulting in injury. The Department’s investigation consisted of an unannounced facility visit, records review, and staff, residents, and outside source interviews. According to the allegation received, Resident #1 (R1) was being assisted by a staff member in their transfer from their bed to their electric scooter. It was alleged that the staff member grabbed both of R1’s hands and pulled them to assist R1 out of bed. R1 informed that staff member that they were in pain from the pulling of their hands, but R1 was already in the process of being transferred to their electric scooter.

[Continued on LIC9099-C]

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
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-20241206105851
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: 04/15/2025
NARRATIVE
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Review of R1’s medical assessment records dated October 23, 2024, revealed that R1 was not confused or disorientated, had motor impairment/paralysis, was able to follow directions and could feed themselves but required staff assistance for all other activities of daily living (ADLs). R1 was not able to independently transfer to and from bed. Review of R1’s needs and service plan dated October 26, 2024, revealed that R1 requires one-person total assistance with transfers. Interviews with staff members corroborated R1’s need for assistance with transfers and explained that R1 has sensitive skin, thus there is a technique needed to be used when transferring R1.

Interviews with staff revealed that, due to R1’s sensitive skin, R1 needs to be grabbed from under the palms when being transferred. In December of 2024, there was a new staff member in training. This staff member was assisting R1 with their transfer from their bed to their electric scooter. Per staff interviews, this trainee grabbed the tops of R1’s hands to transfer them from their bed to their electric wheelchair. Resident and staff interviews corroborated the incident of the trainee grabbing R1 from the top of their hands which resulted in bruising. Interviews with staff and residents revealed the observation of the bruising R1 sustained from the transfer and recalled the bruising lasting about a week.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of evidence exists to support the allegation. One deficiency is being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Resident Services Director , to whom a copy of this report, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20241206105851
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: 04/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2025
Section Cited
CCR
87468.2(a)(4)
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Additional Personal Rights of Residents in Privately Operated Facilities (a) …residents in ... facilities for the elderly shall have all of the following personal rights: (4) to care... and services that are delivered by staff that are sufficient in… competency to meet their needs.
This requirment was not met by evidence of:
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At the time of LPA's visit, S1 was no longer employed by the facility. Licensee agrees to conduct an in-service training for proper transfer techniques of residents' and in-house personal rights training and submit proof and sign-in sheet of training to the Department by POC date 0f 4/29/25.
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Based on record review and interviews the licensee did not comply with the section cited above in that one (1) out of one hundred twelve (112) residents were handled in a rough manner, which posed a potential personal rights and safety risk 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: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
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