306005642-10-27-2020-22-AS-SSAS-BV26E2-20201103194401

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005642
Report Date: 10/27/2020
Date Signed: 10/27/2020 10:26:04 AM

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
06/08/2020 and conducted by Evaluator James August

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200608160102

FACILITY NAME:	CROWN COVE		FACILITY NUMBER:	306005642
ADMINISTRATOR:	OLSEN, KATHLEEN		FACILITY TYPE:	740
ADDRESS:	3901 EAST COAST HIGHWAY		TELEPHONE:	(949) 760-2800
CITY:	CORONA DEL MAR	STATE: CA	ZIP CODE:	92625
CAPACITY:	97	CENSUS: 59	DATE:	10/27/2020
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Kameshi Taylor - Executive Director		TIME COMPLETED:	10:23 AM

ALLEGATION(S):

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Facility requires residents to self isolate and quarantine anytime they leave the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jim August contacted the facility via video telephone to conclude a complaint investigation via telephone due to COVID-19 and precautionary measures. LPA identified himself and discussed the purpose of the call and the elements of the allegation with Kameshi Taylor, Executive Director. The initial 10-day visit was completed on 6/8/2020.

The investigation into the allegation that the facility requires residents to self isolate and quarantine anytime they leave the facility revealed the following:

On 6/8/2020 LPA August and LPM Marina Stanic interviewed (former) Executive Director Brenda Ritter over the phone. Ritter confirmed that the facility had a policy that would require a mandatory quarantine for any resident that left the facility for any reason, even if that resident had not been exposed to, or was asymptomatic to Covid-19. LPM Stanic and LPA August explained that this practice would be a personal rights violation and should cease immediately. CONTINUED ON LIC9099C DATED 10/27/2020.....

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020

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-20200608160102

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: CROWN COVE	FACILITY NUMBER: 306005642
	VISIT DATE: 10/27/2020

NARRATIVE

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Ritter advised the facility would stop this practice immediately and inform residents that the facility would only request residents to volunteer to self isolate after returning to the facility.

LPA August received an email from resident 1 (R1) with a May 29, 2020 letter from the facility to residents and family members. The letter stated, “Please remember that leaving the community will require a 14-day quarantine upon return.”

On June 12, 2020, LPA August received an email from Ritter titled, “Plan of Correction”. The letter indicated that employees were re-trained on June 10, 2020 and that a memo was distributed to residents and family members on June 10, 2020 to clarify that after leaving the community for a non-essential reason, self-isolation is encouraged and not required.

On June 23, 2020, LPA August interviewed residents 2 (R2), and 3 (R3). R2 explained that in early June 2020, he went outside to the facility parking lot for about 30 minutes. As soon as he came back inside the facility he was told by a staff member that he would need to be on a mandatory quarantine for 14 days. He could not leave his room for 14 days. R3 explained that in early June of 2020, she left the facility and upon her return she was forced to quarantine for 14 days. She was told she could not leave her room for 14 days.

On July 8, 2020, LPA August interviewed R1. R1 left the facility sometime in May 2020 and upon his return to the facility on May 13, 2020 was forced to quarantine in his room from May 13, 2020 to May 27, 2020. He did not have any Covid-19 symptoms nor was he exposed to the virus. R1 then left the facility on May 27, 2020, came back the same day and was again forced to quarantine until June 3, 2020.

Based on the above, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D.

An exit interview was conducted with Executive Director Kameshi Taylor - via telephone and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to Taylor via email. Taylor to sign all applicable pages and return to LPA August via email.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20200608160102

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: CROWN COVE	FACILITY NUMBER: 306005642
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/27/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/24/2020 Section Cited CCR 87468.1(a)(6)	1 2 3 4 5 6 7	Residents in all residential care facilities for the elderly shall have all of the following personal rights: To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The licensee submitted a plan of correction to LPA on 6/12/2020 that included a letter to residents and family with an updated policy that does not mandate forced quarantine. The facility has already conducted in service training to all staff as well.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not ensure that residents were free to leave or depart from the facility without being forced to quarantine in their rooms upon return.	8 9 10 11 12 13 14
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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: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020

LIC9099 (FAS) - (06/04)

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