370804788-10-26-2021-08-AS-JRAE-C8A59U-20211029194608

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370804788
Report Date: 10/26/2021
Date Signed: 10/26/2021 01:53:13 PM

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
02/24/2021 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20210224140815

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: 96	DATE:	10/26/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Eveline Denton, Medical Receptionist		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

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Facility is not providing a walker for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Tiffany Holmes conducted a visit to deliver findings on the above allegation. LPA identified herself, spoke with Eveline Denton, Medical Receptionist and disclosed the purpose of the visit.The investigation included interviews and a review of records.
It was alleged that the facility is not providing a walker for resident. On or about February 24,2021, Resident 1 (R1) was walking alone outside with their cane and almost fell. A neighbor observed and reproted to facility that R1 should be walking with a walker. Based on R1’s physician report dated May 2 2018, R1 was ambulatory and can manage their care needs in the areas of toileting, bathing, grooming, and dressing. The report also indicated that R1 can leave the facility unassisted. The physicians report also does not state that R1 uses or needs any assistive devices. Based on interviews conducted and a review of documents, there is insufficient evidence to prove Facility is not providing a walker for resident therefore, the complaint investigation finding is found to be unsubstantiated. An exit interview was conducted with Eveline Denton, Medical Receptionist, and the Licensee’s Rights (LIC9058 01/16) along with a copy of this report was emailed to the facility's email address. A reply email or return receipt from the administrator will confirm receipt of documents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021

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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