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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 134604423
Report Date: 03/14/2023
Date Signed: 03/14/2023 03:08:45 PM

Substantiated


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
10/31/2022 and conducted by Evaluator Elizabeth Hamilton
COMPLAINT CONTROL NUMBER: 08-AS-20221031163039
FACILITY NAME:ROSE CREST ASSISTED LIVINGFACILITY NUMBER:
134604423
ADMINISTRATOR:GUZMAN, VANESSAFACILITY TYPE:
740
ADDRESS:103 S. HASKELL DR.TELEPHONE:
(760) 960-8404
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY:14CENSUS: 7DATE:
03/14/2023
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Administrator, Vanessa Guzman and Facility Assistant, Ana GarciaTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Facility staff did not follow infection control plan.
Facility staff were not trained on medication.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Elizabeth Hamilton and Daniel Pena conducted an unannounced complaint investigation visit at the facility. LPAs were greeted at the front entrance by Caregiver, Christi Mowery and granted entry after identifying themselves. Administrator, Vannessa Guzman and Facility Assistant, Ana Garcia arrived during the visit and LPA Hamilton explained the purpose of the visit which was to deliver findings for the above allegations.

The Department’s investigation consisted of record reviews, interviews with staff, residents, and outside sources.

On October 31, 2022, it was alleged that the facility staff did not follow their infection control plan. More specially, it was alleged that the staff would re-use disposable gloves during resident care and staff were not wearing face masks. Interviews with staff and outside sources revealed that although the facility would run low on gloves for resident care, they were discarded after each use and not used between residents or tasks.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
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-20221031163039
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: ROSE CREST ASSISTED LIVING
FACILITY NUMBER: 134604423
VISIT DATE: 03/14/2023
NARRATIVE
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However, outside source interviews and observations confirmed that all staff did not wear a face mask when working in the facility during this time period.

On October 31, 2022, it was further alleged that facility staff were not trained on medication. Interviews revealed that not all staff at the facility who passed out medication had received medication training during the time in question. However, they were advised to do so by their Superior, staff 1 (S1- See LIC 811 – Confidential Names List). Interviews further specified that staff 2 (S2) who was not trained on medication had disbursed medication on multiple dates to residents in care. Records reviewed confirmed S2 passed out medications to residents in care.

The Department has investigated the allegation of facility staff did not follow infection control plan and facility staff were not trained on medication. Based on evidence obtained, the allegations are substantiated. A substantiated finding means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies are cited in accordance with California Code of Regulations, Title 22, Division 6 Chapter 8, and is listed on the 9099D.

An exit interview was conducted with Administrator Guzman and Facility Assistant Garcia, plans of correction were jointly developed and a copy of this report, LIC 9099D, LIC 811 and Licensee/Appeals Rights (LIC 9058 01/16) was provided.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20221031163039
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: ROSE CREST ASSISTED LIVING
FACILITY NUMBER: 134604423
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2023
Section Cited
CCR
87470
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Infection Control Requirements (F) Staff shall demonstrate knowledge of and skill in infection control, as appropriate to the job assigned and as evidenced by safe and effective job performance. This requirement was not met as evidenced by:
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Administrator stated they would conduct a training on infection control and mask wearing for all staff. They would provide verification of the training and sign in sheet to the Department by 04/04/2023.
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Based on interviews and observations by outside sources, Licensee did not ensure facility staff wore face coverings while working with residents in care. This posed a potential personal rights risk to 9 out of 9 residents in care.
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Type B
04/04/2023
Section Cited
CCR
87411
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Personnel Requirements - General (d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following… (4) Knowledge required to safely assist with prescribed medications which are self-administered. This requirement was not met as evidenced by:
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Administrator stated they would ensure all staff were medication trained and have all staff complete medication training and provide verification to the Department by 04/11/2023.
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Based on interviews and records reviewed, Licensee did not ensure facility staff completed medication training prior to distributing it to residents in care. This posed a potential health and safety risk to 9 out of 9 residents 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.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
10/31/2022 and conducted by Evaluator Elizabeth Hamilton
COMPLAINT CONTROL NUMBER: 08-AS-20221031163039

FACILITY NAME:ROSE CREST ASSISTED LIVINGFACILITY NUMBER:
134604423
ADMINISTRATOR:GUZMAN, VANESSAFACILITY TYPE:
740
ADDRESS:103 S. HASKELL DR.TELEPHONE:
(760) 960-8404
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY:14CENSUS: DATE:
03/14/2023
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:TIME COMPLETED:
11:40 AM
ALLEGATION(S):
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2
3
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9
Licensee did not ensure supply of basic hygiene products were available for residents.
INVESTIGATION FINDINGS:
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13
Licensing Program Analysts (LPAs) Elizabeth Hamilton and Daniel Pena conducted an unannounced complaint investigation visit at the facility. LPAs were greeted at the front entrance by Caregiver, Christi Mowery and granted entry after identifying themselves. Administrator Vanessa Guzman and Facility Assistant, Ana Garcia arrived during the visit and LPA Hamilton explained the purpose of the visit which was to deliver findings for the above allegation.

The Department’s investigation consisted of record reviews, interviews with staff, residents, and outside sources.

On October 31, 2022, it was alleged that Licensee did not ensure a supply of basic hygiene products were available for residents. During the initial onsite visit on November 08, 2022, LPA observed individual resident’s personal hygiene products and incontinence supplies in resident rooms. LPA also observed a cabinet with a sufficient supply of additional personal hygiene products and a storage closet with a sufficient supply of incontinence products.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20221031163039
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: ROSE CREST ASSISTED LIVING
FACILITY NUMBER: 134604423
VISIT DATE: 03/14/2023
NARRATIVE
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Interviews with staff and outside sources confirmed some residents had their own supply of personal hygiene products in their rooms and staff and outside sources were able to use the facility’s supply as residents needed. Interviews with staff further confirmed the residents had run low in the past on their incontinence products; however, the facility had extra supplies to supplement until resident’s personal supply was replenished. Interviews with outside sources did not indicate related concerns. There was insufficient evidence to support the allegation Licensee did not ensure supply of basic hygiene products were available to residents.

The Department has investigated the above allegation. Based on evidence obtained, including interviews and records reviewed, the allegation is determined as unsubstantiated as the Department could not meet the preponderance of the evidence standard.

An exit interview was conducted with Administrator Guzman and Facility Assistant Garcia and a copy of this report and Licensee/Appeals Rights (LIC 9058 01/16) was provided.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5