306005642-12-12-2023-22-AS-AORZ-CYPN44-20231220090718

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005642
Report Date: 12/12/2023
Date Signed: 12/12/2023 04:06:51 PM

Unsubstantiated

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
11/09/2021 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211109133758

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: 63	DATE:	12/12/2023
		UNANNOUNCED	TIME BEGAN:	01:01 PM
MET WITH:	Carrie Galloway, Executive Director and Gerardo Garibay, Business Office Manager		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Staff is not providing adequate care and supervision to the residents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose to conduct additional interviews, review documentation and conclude findings for complaint allegations listed above. LPA Quiroz was greeted and granted entry by front desk concierge. LPA met with Business Office Manager (BOM) Gerardo Garibay and Executive Director (ED) Carrie Galloway and explained the nature of the visit. The 10 day visit was conducted on 11/18/2021 by LPA Quiroz.
During the course of the investigation, LPAs conducted interviews with interviewees consisting of staff and Residents. LPA Quiroz also conducted documentation review but not limited to resident roster, staff roster, physician report, identification form, needs and services plan and staff schedules.
Regarding the allegation " Staff is not providing adequate care and supervision to the residents," the investigation revealed the following: Title 22 regulation states: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Interviews conducted with Fourteen of fifteen interviewees concluded that currently facility is providing adequate care and supervision to the residents in care, indicating not able CONTINUED ON NEXT LIC 9099-C PAGE...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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 2

Control Number 22-AS-20211109133758

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: 12/12/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

CONTINUED...to provide feedback for staffing ratios for 2020 year. Eight of fifteen interviewees indicated having no knowledge of facility during complaint time-frame. Seven of fifteen interviewees indicated that staffing was challenging during COVID-19 pandemic due to staffing call offs, acuity due to COVID-19 pandemic and relying on Agency staffing. (ED) Galloway indicated “We are fully staff currently, however still actively hiring for back up/on call positions to fill in. We stopped using Agency staff effective 2/28/2023.” Scheduling records from February 2020 to June 2020 revealed that facility had 2-4 caregivers scheduled on AM shift, 2-3 caregivers scheduled on PM shift, and 2-4 caregivers on the NOC shift varying on Assisted Living and Memory Care Unit. Facility census at the time of complaint was 33 residents.
During today's facility inspection visit, LPA Quiroz observed pull chords throughout the facility including hallways, bathroom areas and common living areas and resident bathroom areas. LPA Quiroz observed resident carrying pendants on their possession readily available to call for assistance when needed.
Documentation review of Staffing schedules for November 2023 and December 2023 reveal facility is currently staffing the following staff in Assisted Living area: 3 caregivers, 2 shared medication technicians, shared Memory Care Director, and shared Resident Care Coordinator with memory care unit on AM Shift, 2-3 caregivers, 1 shared medication technician with memory care unit on PM shift and 1-2 caregivers and 1 shared medication technician with memory care unit on NOC shift.
Documentation review of Staffing schedules for November 2023 and December 2023 reveal facility is currently staffing the following staff in Memory Care Unit: 2-3 caregivers, 2 shared medication technicians, shared Memory Care Director, and shared Resident Care Coordinator with Assisted Living Unit on AM Shift, 2 caregivers, 1 shared medication technician with Assisted Living Unitt on PM shift and 1-2 caregivers and 1 shared medication technician with Assisted Living Unit on NOC Shift.
(ED) Galloway indicated that "a staff gross for 2024 budget has been approved, and will be implemented as census gross to continue to able to provide good quality care services to residents in care."

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegation “Staff is not providing adequate care and supervision to the residents” is deemed Unsubstantiated.

An exit interview was conducted with (ED) Galloway and a copy of this report was provided at exit.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2