370804788-2-10-2021-08-AS-IESA-BZNA4R-20210331235357

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370804788
Report Date: 02/08/2021
Date Signed: 02/10/2021 11:08:23 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/17/2020 and conducted by Evaluator Evangelica Torres

COMPLAINT CONTROL NUMBER: 08-AS-20200617105030

FACILITY NAME:	CASA EL CAJON		FACILITY NUMBER:	370804788
ADMINISTRATOR:	REBECCA RAYO		FACILITY TYPE:	740
ADDRESS:	306 SHADY LANE		TELEPHONE:	(619) 440-1335
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY:	99	CENSUS: 90	DATE:	02/08/2021
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Caregiver, Eveline Denpon		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee failed to meet Resident's #1 needs

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA), Eva Torres conducted a virtual visit via Zoom to deliver findings on the above allegation, due to COVID-19. LPA identified herself, spoke with Caregiver, Eveline Denpon, and disclosed the purpose of the phone call. The investigation included interviews and a review of records.

It was alleged that the facility was not meeting Resident #1 (R1) (See LIC 811- Confidential Names List for R1) needs.

On or about June of 2008, R1 was admitted into the facility. Based on R1’s physician report dated January 22, 2019, R1 was ambulatory and can manage their care needs in the areas of toileting, bathing, grooming, and dressing. Also, R1’s cognitive state was found to be within normal limits as the mental examination revealed no evidence of confusion. The report also indicated that R1 can leave the facility unassisted. However, on May 1, 2020, the facility updated its care plan to reflect the changes in R1’s needs, as R1 was requiring constant verbal reminders and prompts to address their episodes of non-compliance behavior.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Evangelica Torres	TELEPHONE: (619) 900-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2021

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 08-AS-20200617105030

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CASA EL CAJON	FACILITY NUMBER: 370804788
	VISIT DATE: 02/08/2021

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

According to a review of the treating medical agency’s records, on June 3, 2020, R1 was seen by the agency to assess the changes in R1’s behavior. At that time, the agency felt that R1 did not meet the criteria for additional support.

On June 19, 2020, R1 sustained an unwitnessed fall while at the facility. As a result, R1 was transported to the hospital, examined, and returned with an assistive device for ambulatory purposes.

On July 01, 2020, R1 followed up with the treating agency. At that time, the administrator voiced their concern about R1’s change in their level of care. On July 15, 2020, the administrator called the agency and reported additional changes in R1’s physical and mental state. Thereby, R1 was transported to the treating agency for an evaluation, in which the exam confirmed an overall change in R1’s condition. Based on that assessment, it was jointly agreed among the providers that R1 required a higher level of care.

LPA interviewed a random sampling of residents, including the responsible parties, and their interviews did not support the allegation. R1’s interview produced inconsistencies due to their cognitive impairment, as they were unable to remember the facility mentioned above. Staff declined the allegation, as the records reflect their persistence in voicing R1’s change in condition to the treating agency.

Based on interviews conducted and a review of documents, there is insufficient evidence to prove or disprove that the allegation occurred; therefore, the complaint investigation findings are found to be unsubstantiated. An exit interview was conducted with caregiver Eveline Denpon, and the Licensee’s Rights (LIC9058 01/16) along with a copy of this report was forwarded to the facility's email address. A reply email or return receipt from the administrator will confirm receipt of documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Evangelica Torres	TELEPHONE: (619) 900-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2