370804823-1-20-2023-08-AS-SJAB-CNKRBH-20230130115246

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370804823
Report Date: 01/18/2023
Date Signed: 01/20/2023 08:42:35 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
01/28/2021 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20210128122256

FACILITY NAME:	ST. PAUL'S VILLA		FACILITY NUMBER:	370804823
ADMINISTRATOR:	ELEANOR DOWNING		FACILITY TYPE:	740
ADDRESS:	2340 FOURTH AVENUE		TELEPHONE:	(619) 232-2996
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92101
CAPACITY:	200	CENSUS: 102	DATE:	01/18/2023
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	LaTressa Downing, Administrator		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility restricted resident's access to their physician

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced visit to the facility to deliver investigative findings regarding the above-mentioned allegation. LPA identified himself, explained the purpose of the visit and nature of the complaint to Administrator, LaTressa Downing.

On 1/28/2021, the Department received this complaint which alleged, the facility restricted a resident's access to their physician. The Department’s investigation included, virtual and onsite physical plant tours, record reviews and interviews with residents, staff and outside sources.

A review of facility records which included Resident 1’s (R1) Face Sheet, Admission Agreement, Resident Appraisal, Appraisal Need and Services Plan, Physician's Report, Record of Centrally Stored Medications and Hospice Contract. R1 was admitted into the facility on 1/2/2021 diagnosed with encephalopathy, pneumonia, COPD, pulmonary mycobacterial infection, sepsis and vitamin deficiency. R1's records noted two physicians, a primary care and attending hospice physician.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

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 08-AS-20210128122256

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ST. PAUL'S VILLA	FACILITY NUMBER: 370804823
	VISIT DATE: 01/18/2023

NARRATIVE

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R1 records reflected that R1 was non-ambulatory and required assistance with bathing, hair care, personal hygiene, toileting and medication management.

A Durable Power Of Attorney (DPOA) served as R1’s financial and healthcare representative and also served as R1’s emergency contact. According to a statement from the DPOA, in 2021, R1 became ill and was placed into a Skilled Nursing Facility (SNF). When R1 was recovered, they were moved into St. Paul's Villa. When asked, DPOA informed LPA that there was never a problem for R1 to obtain healthcare from their physicians. DPOA said R1 was 99 years old in January 2021 but healthy and lucid at that time. R1 told the DPOA that they did not want to spend time in a hospital anymore and wanted to receive hospice services instead. A hospice service was selected, and St. Paul's Villa arranged for them to provide hospice services to R1 at the facility. The hospice group brought in all of their needed equipment and administered hospice services to R1. DPOA stated that R1’s hospice group was very attentive to R1’s needs. DPOA said neither of R1’s physicians called the DPOA to express concerns with R1’s transition to hospice nor did neither physician claim R1 was not accessible to them. DPOA said R1 was never denied access to medical care nor were they denied the ability to communicate with their physicians. DPOA said R1’s primary care provider remained their doctor until they passed on 12/3/2022.

In February 2021, R1 was interviewed as part of this investigation. At the time of the interview, R1 resided at St. Paul's Villa in an Assisted Living room. R1 told LPA that they were receiving hospice care and recently transferred from a SNF for a leg injury. R1 said hospice nurses visited them twice in the previous two weeks. Mainly, the nurses talked with R1. R1 did not know much about their hospice contract and said their DPOA handled those affairs. R1 said they were healthy and only in the last two years experienced a decline in their health. R1 had a lung infection. R1 said their medical records are small due to their good health. When asked, R1 said they have no concerns with accessing care from their primary physician.

The Department has investigated the allegation that the facility restricted a resident’s access to their physician. Based upon the information obtained during this investigation; it is determined that although the incident may have happened and is valid, there is not a preponderance of evidence to prove it occurred and is therefore UNSUBSTANTIATED.

An exit interview was conducted with Administrator Downing, to whom a copy of this report and the Licensee's Rights (LIC9058 01/16) were provided via hard copy.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC9099 (FAS) - (06/04)

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