306003905-5-6-2022-22-AS-LADS-CFNR2H-20220623123821

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003905
Report Date: 05/06/2022
Date Signed: 05/06/2022 04:44:01 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/29/2022 and conducted by Evaluator Joseph Alejandre

COMPLAINT CONTROL NUMBER: 22-AS-20220429144159

FACILITY NAME:	AEGIS ASSISTED LIVING OF LAGUNA NIGUEL		FACILITY NUMBER:	306003905
ADMINISTRATOR:	ERIC MEDOR		FACILITY TYPE:	740
ADDRESS:	32170 NIGUEL ROAD		TELEPHONE:	(949) 496-8080
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY:	96	CENSUS: 64	DATE:	05/06/2022
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Al Otieno		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff are not allowing Ombudsman to bypass COVID-19 vaccination screening.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to begin the investigation into the allegation listed above. LPA was greeted and granted entry into the facility. LPA explained the reason for the visit. LPA met with General Manager Al Otieno LPA interviewed the General Manager. The investigation revealed the following; On 3/29 and 4/26, 2 Ombudsmen for the Council on Aging Southern California visited the facility. The Ombudsmen (2) were allowed into the entry way of the facility. Facility staff informed the Ombudsmen they must check in and complete the Covid-19 screening process. During each visit the General Manager was not present at the facility. It was reported and verified that once the screening was completed the Ombudsmen were allowed into the facility on each date. The Ombudsmen informed the staff on 3/29 that they are exempt from the verification/screening process as stated in Provider Information Notice PIN 22-07 ASC dated 2/7/22, which states on page 7, "Vaccination and testing requirements and associated verification and record keeping conditions do not apply to:... visits mandated by a court order or federal law such as visits by Adult Protective Services or the Long Term Care Ombudsman.". Continued on LIC 9099C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

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 22-AS-20220429144159

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: AEGIS ASSISTED LIVING OF LAGUNA NIGUEL	FACILITY NUMBER: 306003905
	VISIT DATE: 05/06/2022

NARRATIVE

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The General Manager reported that in each instance he was not at the facility. The General Manager verified that the staff did require the Ombudsman to check in and go through the sign in process. Even though the Ombudsmen were required to go through the sign in process they were granted entry into the facility after being delayed for a short time. The General Manager reported that staff have been retrained and are aware of all the exceptions to the screening process. Based on the evidence gathered through interviews the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report along with citations and Appeal Rights (LIC 9058 01/16) was provided to the General Manager.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20220429144159

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: AEGIS ASSISTED LIVING OF LAGUNA NIGUEL	FACILITY NUMBER: 306003905
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/06/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/16/2022 Section Cited CCR 87468.1(a)(11)	1 2 3 4 5 6 7	87468.1(a)(11) Personal Rights of Residents in All Facilities. To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon.	1 2 3 4 5 6 7	The General Manager agrees that all reception staff will be retrained on visiting requirements (PIN 22-07-ASC, 2/7/22) for all visitors including special visitors including all CDSS staff and Ombudsmen and Health Departmen officials and on Personal Rights of Residents in All Facilities CCR 87468.1
	8 9 10 11 12 13 14	This requirement is not being met, as evidenced by, based on evidence gathered through interviews, facility required the Ombudsmen to go through the screening verification process which delayed their entry in the facility which poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14	The General Manager will forward proof of training to LPA by POC due date.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

LIC9099 (FAS) - (06/04)

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