306005642-12-12-2023-22-AS-AORZ-CYNRC2-20231219115337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005642
Report Date: 12/12/2023
Date Signed: 12/12/2023 03:57:05 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
08/26/2020 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200826161002

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:	09:17 AM
MET WITH:	Carrie Galloway, Executive Director and Gerardo Garibay, Business Office Manager		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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-Facility does not have adequate staffing to meet the resident's needs.

INVESTIGATION FINDINGS:

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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 allegation 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 8/31/2020 by LPA Patricia Velazquez.
During the course of the investigation, LPAs conducted interviews with interviewees consisting of staff and Residents, conducted facility tour observations and 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 "Facility does not have adequate staffing to meet the resident's needs," 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 Nine of fifteen interviewees concluded that currently facility 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)

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Control Number 22-AS-20200826161002

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

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CONTINUED... does have adequate staffing to meet the resident’s needs and not able to provide feedback for staffing ratios for year 2020 indicating having no knowledge of facility staffing during that time. 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 as needed. 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 65 residents.
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 she has requested increase staffing for 2024 budget as the census has increased and 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 "Facility does not have adequate staffing to meet the resident's needs" 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)

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