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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604611
Report Date: 09/19/2023
Date Signed: 09/19/2023 03:30:36 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/16/2023 and conducted by Evaluator Rebecca A Ruiz
COMPLAINT CONTROL NUMBER: 08-AS-20230616125114
FACILITY NAME:IDEAL HOME CAREFACILITY NUMBER:
374604611
ADMINISTRATOR:HULSEY, JOSEFINA I.FACILITY TYPE:
740
ADDRESS:3337 STOCKMAN STREETTELEPHONE:
(619) 272-2663
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:6CENSUS: 4DATE:
09/19/2023
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Facility Manager Ben RosarioTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Licensee did not meet resident's care needs
Licensee did not meet resident's incontinence needs
Licensee did not provide copies of admission agreement
Staff broke resident's personal property
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to conduct follow-up and deliver findings regarding the above-mentioned allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Facility Manager Ben Rosario.

During today’s visit, LPA observed residents in care and interviewed staff.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that Licensee did not meet resident’s incontinence needs, Licensee did not provide copies of admission agreement, staff broke residents personal property, and Licensee did not meet residents care needs. Review of medical records revealed that Resident 1 (R1) did not have any memory impairment, was not confused or disoriented, was able to follow directions, make their needs known, and was continent of bladder and bowels.
Continued on LIC9099-C page...
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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-20230616125114
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: IDEAL HOME CARE
FACILITY NUMBER: 374604611
VISIT DATE: 09/19/2023
NARRATIVE
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Interviews with R1 and the Licensee revealed that R1 was unable to get out of bed independently, was bedridden, and required assistance with incontinence care. Interviews and assessment records revealed that R1 had a history of agitation and unpleasant and rude behaviors with interacting with others. Interviews with the staff and Licensee revealed that the staff at the facility are live-in and were responsible for assisting residents with activities of daily living (ADLs), preparing meals, maintaining the cleanliness of the facility, and passing medications. Interviews and LPA observation revealed that residents called for assistance by using bells or verbally called for staff. Review of communication from R1’s physician dated June 2023 revealed that R1 was unable to walk independently and was bed bound. Review of R1’s assessment document revealed that R1 needed a hoyer lift and leg brace for transportation. Interviews with staff revealed that they repositioned bedridden residents every 2-3 hours in bed and stated that they would occasionally use the hoyer lift to reposition a resident. Interviews with staff revealed that they had received training to properly used the hoyer lift.

It was alleged that staff broke resident’s personal property, specifically a cell phone that was damaged during a physical altercation with a staff member. Interviews were not able to verify if the phone was physically damaged or unable to operate. Interviews revealed that R1 had a working cell phone that R1 used to contact people. Interviews with staff revealed that R1 would accidentally drop their cell phone and would call staff to pick the cell phone up off the floor. The Licensee stated that she replaced the battery in R1’s phone due to the multiple drops to the floor. Interviews with staff and the Licensee denied any instances of hitting, punching, slapping, or any other actions that would have broken R1’s cell phone. Interviews revealed that R1 called the police twice regarding verbal disagreements between R1 and the facility, and no arrests were made at either police visit. Interviews revealed that R1 yelled at staff during both police visits. Interviews with residents and outside sources did not reveal any issues with the care provided by staff and described facility staff as very responsive to resident care needs as well as communication with family members. Interviews with residents, staff, and outside sources denied hearing staff have raised voices, yelling, screaming, or rude words. Interviews with staff and the Licensee did not reveal any evidence of the Licensee or staff hitting, slapping, punching, or physically abusing residents.

Continued on LIC9099-C page...

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20230616125114
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: IDEAL HOME CARE
FACILITY NUMBER: 374604611
VISIT DATE: 09/19/2023
NARRATIVE
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Records review revealed that R1 moved into the facility in May 2023. Interviews with the Licensee revealed that the Licensee would provide copies of the admission agreement either electronically or hard copies, depending on location of the signing party. Interviews revealed that R1 was their own responsible party and review of the facility’s copy of R1’s admission agreement signed in May 2023 revealed R1’s signature at the end of the document confirming that R1 received a copy of the admission agreement. Interviews with outside sources disputed the complaint allegation and confirmed that the Licensee provided copies of the admission agreement and other documents during the admission process.

Interviews with staff revealed that all residents required incontinence care and wore incontinence briefs. Interviews with residents revealed that staff checked on residents roughly every hour during the day and at least once overnight and changed residents’ incontinence briefs roughly four times a day. Interviews with staff did not provide consistent information regarding the timing of checks but confirmed that staff checked on and changed residents’ incontinence briefs multiple times a day. Interviews with staff revealed that R1 was unable to get out of bed, did not use incontinence briefs, had an external incontinence care device that emptied into a container, and required assistance with the incontinence device. Interviews with staff revealed that R1 would call for staff to empty the device multiple times a day due to frequent urination. Interviews with residents did not reveal any instances where residents were left in soiled incontinence briefs or developed any skin conditions or breakdown due to being left in soiled incontinence briefs. During multiple on site visits in June and September 2023, LPA did not smell any urine or feces in common areas or resident rooms.

The Department has investigated the above-mentioned allegations and based on interviews, records review, and LPA observations, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated.

An exit interview was conducted with Facility Manager Ben Rosario, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3