306004792-6-13-2022-22-AS-AORZ-CFNMFM-20220623093434

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004792
Report Date: 06/13/2022
Date Signed: 06/13/2022 01:32:50 PM

Unfounded

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
03/25/2022 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20220325153809

FACILITY NAME:	FOUNTAINS AT THE SEA BLUFFS, THE		FACILITY NUMBER:	306004792
ADMINISTRATOR:	TERRY BROWN		FACILITY TYPE:	740
ADDRESS:	25421 & 25401 SEA BLUFFS DRIVE		TELEPHONE:	(949) 443-9543
CITY:	DANA POINT	STATE: CA	ZIP CODE:	92629
CAPACITY:	88	CENSUS: 58	DATE:	06/13/2022
		UNANNOUNCED	TIME BEGAN:	12:01 PM
MET WITH:	Terry Brown and Andrea Furch		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Residents not allowed to eat in dining room due to inadequate staffing.
Facility is not following COVID-19 guidelines.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of delivering findings on the above allegations. LPA was greeted and granted entry into the facility by Executive Director Terry Brown and explained the reason for the visit. Program Director Andrea Furch was present as well.
During the complaint investigation, LPA toured the facility as well as interviewed staff and residents. Regarding the allegations that facility is not following COVID-19 guidelines and residents are not allowed to eat in dining room due to inadequate staffing, the investigation revealed the following: LPA toured the facility on two different occasions and observed all covid precautions are in place. Facility has a check in station at the entrance of the facility with ample large signage. The check in station has a series of questions along with mandatory temperature taking. Once completed, visitors receive a paper badge indicating they have been screened. LPA observed visitors being screened as well as wearing masks. LPA observed all staff encountered during visits were wearing masks. Facility had been encountering staffing challenges once facilities were able to fully re-open due to pandemic. CONTINUED ON LIC 9099C DATED 06/13/2022.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022

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-20220325153809

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: FOUNTAINS AT THE SEA BLUFFS, THE	FACILITY NUMBER: 306004792
	VISIT DATE: 06/13/2022

NARRATIVE

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Administrator and Program Director state residents in assisted living were provided to-go meals in their rooms or could eat the meals in the library at tables if they chose due to industry wide staffing shortages. Some of the assisted living residents utilized the library for meals and others opted to eat in their rooms. Memory care and enhanced assisted living residents ate in their respective dining rooms. Facility was actively recruiting staff members through varied venues. Dining room has since re-opened fully on 05/02/2022 and was re-opened for partial meals on 03/28/2022. Facility residents and families were notified about the closures and re-openings via announcements which were provided to LPA. Program Director indicates only personal notification regarding eating in the library. During the investigation, LPA interviewed eight residents. Eight out of eight residents confirmed no issues with meals and were aware of the option to eat their meals in the library if they chose. Although there were staffing shortages in the dining room, facility ensured all meals were provided three times a day and the option for communal dining in the library was available. Therefore the allegations are deemed unfounded meaning the allegations are false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022

LIC9099 (FAS) - (06/04)

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