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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 134602495
Report Date: 09/07/2023
Date Signed: 10/26/2023 11:59:37 AM

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
05/25/2023 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20230525143229
FACILITY NAME:CASA ELITEFACILITY NUMBER:
134602495
ADMINISTRATOR:IRMA PINEDAFACILITY TYPE:
740
ADDRESS:1785 CITRUS LANETELEPHONE:
(760) 352-9591
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY:8CENSUS: 6DATE:
09/07/2023
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Administrator, Irma PinedaTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff administered unprescribed marijuana to residents
INVESTIGATION FINDINGS:
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This is an amended report to a report signed on 9/7/2023.
Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to deliver findings. The LPA introduced himself and disclosed the purpose of the visit to Administrator, Irma Pineda.

Throughout the investigation, the Department secured pertinent records and conducted interviews with staff, residents and external sources.

It was alleged staff administered unprescribed marijuana to residents in care. It was reported to the Department facility staff had provided residents with Marijuana tea and cannabis oil.
Review of records collected at the facility revealed several residents had written physician orders for cannabis. The orders consisted of cannabinoid oil and cannabis infused gummies. Interviews with internal and external sources revealed the facility staff had used dried cannabis leaves to make and provide residents with Marijuana tea. Cannabis oil had also been provided to the residents by staff. (See LIC 9099-C for continuation of report.)
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
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 5
Control Number 08-AS-20230525143229
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: CASA ELITE
FACILITY NUMBER: 134602495
VISIT DATE: 09/07/2023
NARRATIVE
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 The cannabis oil was stored in glass jars, not labeled with instructions, dosage, quantity, nor resident information.

During a visit to the facility, the LPA observed a glass jar containing dried cannabis leaves. The jar containing the dried cannabis leaves was not labeled with instructions, dosage, quantity, nor resident identifying information. The administrator confirmed staff had used the dried cannabis leaves to make tea for residents in the past.

Based on the evidence gathered throughout the investigation, there was not a preponderance of evidence, therefore, the allegation was unsubstantiated.

An exit interview was conducted with Pineda, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058), were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
05/25/2023 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20230525143229

FACILITY NAME:CASA ELITEFACILITY NUMBER:
134602495
ADMINISTRATOR:IRMA PINEDAFACILITY TYPE:
740
ADDRESS:1785 CITRUS LANETELEPHONE:
(760) 352-9591
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY:8CENSUS: 6DATE:
09/07/2023
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Administrator, Irma PinedaTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff placed resident on a special diet without physician orders
Staff did to treat resident with dignity
Staff did not provide activities for residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to deliver findings. The LPA introduced himself and disclosed the purpose of the visit to Administrator, Irma Pineda.

Throughout the investigation, the Department secured pertinent records and conducted interviews with internal and external sources.

It was alleged staff placed a resident on a special diet without a physician’s order. It was reported to the Department Resident #1 (R1) was placed on a strict diet by the facility staff. Interviews with internal and external sources did not reveal any concerns regarding residents being placed on strict diets. An interview with R1 revealed R1 had decided to place R1 on a diet due to an increase in weight gain. R1 confirmed it was R1’s choice and the facility had not imposed a diet on R1.
(See LIC 9099-C for continuation of report.)
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20230525143229
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: CASA ELITE
FACILITY NUMBER: 134602495
VISIT DATE: 09/07/2023
NARRATIVE
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It was alleged staff did to treat residents with dignity. It was reported to the Department staff had retaliated against residents when residents did not do as staff asked. Interviews with internal and external sources did not reveal any concerns regarding staff not treating resident with dignity.

It was alleged staff did not provide activities for residents. Interviews with internal and external sources reported witnessing staff encouraging residents to participate in activities. These activities included walking, exercising, and bingo, among others.

Based on the evidence gathered throughout the investigation, there was not a preponderance of evidence to prove the alleged violations occurred, therefore, the allegations were Unsubstantiated.

An exit interview was conducted with Pineda, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058) were provided
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20230525143229
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: CASA ELITE
FACILITY NUMBER: 134602495
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
09/07/2023
Section Cited
CCR
87465(a)(5)(A)
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87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (5) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered medications shall be limited to the following: (A) Medications usually prescribed for self-administration which have been authorized by the person's physician. This requirement was not met as evidenced by:
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Administrator agreed to provide in service training to all staff regarding asisstance with self administered medication.
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Based on interviews and observations, the Licensee did not ensure staff only assisted residents with medication prescribed by a resident's physician, which posed an immediate health, safety and personal rights risk to 3 of 6 residents in care.
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Administrator will provide a training date to the LPA by 9/8/23. Once training is complete, administrator will send the LPA proof.

Administrator will work with physicians to obtain orders for all different uses of prescribed cannabis.
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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.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5