374604425-8-2-2023-08-AS-LTEZ-CV5VFL-20230828162408

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604425
Report Date: 08/02/2023
Date Signed: 08/02/2023 11:14:58 AM

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
11/29/2022 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20221129155406

FACILITY NAME:	LA JOLLA CASA FIESTA		FACILITY NUMBER:	374604425
ADMINISTRATOR:	FERNANDEZ, JENNIFER		FACILITY TYPE:	740
ADDRESS:	5426 AVENIDA FIESTA		TELEPHONE:	(858) 775-6935
CITY:	LA JOLLA	STATE: CA	ZIP CODE:	92037
CAPACITY:	6	CENSUS: 5	DATE:	08/02/2023
		UNANNOUNCED	TIME BEGAN:	10:42 AM
MET WITH:	Tiffany Lynch, House Manager		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Licensee made false claims
Licensee did not ensure the food provided was of good quality
Licensee did not ensure the facility was clean
Administrator not on the premises a sufficient number of hours

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Tiffany Lynch, House Manager.

On 11/29/22 it was alleged that the Licensee made false claims, did not ensure the food provided was of good quality, did not ensure the facility was clean, and the Administrator was not on the premises a sufficient number of hours. The Department’s investigation consisted of two unannounced facility tours, review of facility and outside source records, interviews with facility staff, residents, outside sources, and LPA direct observations.

Regarding the first allegation, "Licensee made false claims", it was alleged that the facility's online advertisements were misleading regarding furniture, food service, and activities/therapies provided. On two unannounced facility visits LPA observed the items and programming in question.
(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

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-20221129155406

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: LA JOLLA CASA FIESTA	FACILITY NUMBER: 374604425
	VISIT DATE: 08/02/2023

NARRATIVE

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(Continued from LIC9099)

LPA observed the facility furniture to be the same and/or similar in nature to the furniture photos and videos on the website. Records review of food menus and activities showed that residents are being offered variety and quality in both categories and within the requirements of Title 22 regulations. Staff interview revealed that while residents are offered the calendared activities, they will decline to participate at times or ask for a different activity. Records review and outside sources interviewed confirmed that staff assist residents with required therapies.

Regarding the second allegation, "Licensee did not ensure the food provided was of good quality", it was alleged that the Licensee did not provide a variety of protein and offered low amounts of vegetables and fruit. Staff interview revealed that residents are provided nutritional meals 3 times per day, with snacks. Interview revealed that at times the food offerings are adjusted based on what is available at the facility, but the meal service is not disrupted. Residents can request a different food option if they are not interested in what is offered. Outside source interview revealed no concerns regarding food service at the facility, and that residents enjoy the meals. Records review of the food menu showed the food options to meet the dietary requirements of Title 22.

Regarding the third allegation, "Licensee did not ensure the facility was clean", Staff interview revealed that staff are responsible for daily cleaning tasks during their shifts. Cleaning tasks include sweeping and mopping, cleaning bathrooms, sanitizing counters and tables, and resident laundry. Deep cleaning tasks such as cleaning window blinds are completed every 1-2 months. Outside source interview revealed that the facility is clean and organized. Outside sources did not have concerns regarding the cleanliness of the facility. On two unannounced facility visits LPA directly observed the facility to be clean, without obstructions or hazards, and no odors that would indicate unsanitary conditions.

(Continued on LIC9099-C)

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20221129155406

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: LA JOLLA CASA FIESTA	FACILITY NUMBER: 374604425
	VISIT DATE: 08/02/2023

NARRATIVE

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(Continued from LIC9099-C)

Regarding the fourth allegation, "Administrator not on the premises a sufficient number of hours", Staff interview revealed that the Administrator is on the premises between 15-30 minutes each week. Title 22 87405(a) states, "…The administrator ... shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration". Staff and outside interviews revealed the facility House Manager to be the designated staff qualified to complete the necessary administration tasks at the facility. Interview revealed the House Manager to be present at the facility full time and also available and responsive via phone while not at the facility. On two unannounced facility visits LPA directly observed the House Manager present at the facility; House Manager was observed to have intimate knowledge of the facility, resident care, and staff management situations. During these facility visits the House Manager answered all questions regarding how the facility was managed and produced all requested paperwork.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Tiffany Lynch, House Manager, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC9099 (FAS) - (06/04)

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