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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370808459
Report Date: 05/29/2024
Date Signed: 05/29/2024 04:05:42 PM

Substantiated


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
05/21/2024 and conducted by Evaluator Dawn Segura
COMPLAINT CONTROL NUMBER: 08-AS-20240521113204
FACILITY NAME:BIGNELL HOME CAREFACILITY NUMBER:
370808459
ADMINISTRATOR:LIBRADA RAMOSFACILITY TYPE:
735
ADDRESS:7345 BIGNELL DRIVETELEPHONE:
(619) 470-4531
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:4CENSUS: 2DATE:
05/29/2024
UNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Rene Ramos, StaffTIME COMPLETED:
04:18 PM
ALLEGATION(S):
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9
Licensee did not ensure medication was inaccessible to clients.

Licensee did not maintain accurate medication administration record.

Licensee did not retain accurate record of client resources.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to commence and conduct a complaint investigation. LPA was granted entry into the facility and met with Rene Ramos, Staff, to whom LPA disclosed the reason for the visit.

Community Care Licensing (CCL) has investigated the above-listed complaint allegations. The investigation consisted of a tour of the facility, review of records, and interview of staff.

It was reported to Community Care Licensing that the licensee did not ensure that medications were inaccessible to clients. During today’s visit, LPA observed that there was a bottle of generic Pepto Bismol, two vials of liquid vitamin B-12, a protein beverage, and Ensure stored unlocked in the refrigerator, which is accessible to clients in care.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
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 6
Control Number 08-AS-20240521113204
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: BIGNELL HOME CARE
FACILITY NUMBER: 370808459
VISIT DATE: 05/29/2024
NARRATIVE
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The second allegation is that the licensee did not maintain accurate medication administration record. It was reported that the medication administration record was dated to reflect that the following day’s medication had already been administered. Interview with staff during the visit revealed that on the date in question, medication had been administered; however, the medication administration record had not been signed to reflect administration of the medication.

The third allegation is that the licensee did not maintain accurate records of client resources. It was reported that client Personal and Incidental (P&I) logs did not reflect the balance retained on behalf of the client, and Client 1’s (C1) log did not reflect a signature or any method that indicated client’s receipt of funds. During today’s record review, LPA observed that the P&I logs of both clients reflected balances of funds; however, records reflected that prior to 4/16/2024, disbursements from C1’s funds were not signed, initialed, or indicated by C1 in any way.

Accordingly, the above listed allegations are substantiated. This finding means that the preponderance of the evidence standard has been met and the allegations are valid. Deficiencies are cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and noted on the attached LIC 9099-D.

An exit interview was conducted with Rene Ramos, and copies of this report and Licensee/Appeal Rights (LIC 9058) were provided at the conclusion of the visit. Rene Ramos' signature below serves as acknowledgment of receipt of copies of the report and rights.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
05/21/2024 and conducted by Evaluator Dawn Segura
COMPLAINT CONTROL NUMBER: 08-AS-20240521113204

FACILITY NAME:BIGNELL HOME CAREFACILITY NUMBER:
370808459
ADMINISTRATOR:LIBRADA RAMOSFACILITY TYPE:
735
ADDRESS:7345 BIGNELL DRIVETELEPHONE:
(619) 470-4531
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:4CENSUS: 2DATE:
05/29/2024
UNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Rene Ramos, StaffTIME COMPLETED:
04:18 PM
ALLEGATION(S):
1
2
3
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5
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9
Licensee did not have food menus.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to commence and conduct a complaint investigation. LPA was granted entry into the facility and met with Rene Ramos, Staff, to whom LPA disclosed the reason for the visit.

Community Care Licensing (CCL) has investigated the above-listed complaint allegation. The investigation consisted of a tour of the facility and interview of staff.

It was reported to Community Care Licensing that the licensee did not have or maintain written menus. During the investigation visit, staff provided to LPA four laminated menus, each of which reflected weekly menus for all meals and snacks for each week of the month. The menus were stored attached to the refrigerator door. Staff interview and LPA’s observation indicated that the menus were not newly created and also indicated that the menus had been maintained by the facility.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 08-AS-20240521113204
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: BIGNELL HOME CARE
FACILITY NUMBER: 370808459
VISIT DATE: 05/29/2024
NARRATIVE
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Based upon the foregoing, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted with Rene Ramos, and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to the staff at the conclusion of the visit. Staff’s signature confirms receipt of the report and rights.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 08-AS-20240521113204
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: BIGNELL HOME CARE
FACILITY NUMBER: 370808459
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/05/2024
Section Cited
CCR
80075(k)(1)
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Health Related Services. Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met, as evidenced by:

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Staff offered to purchase a lockbox to store medications in the refrigerator. Photos of the lockbox and receipt will be provided to Community Care Licensing by the POC due date.
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Based on LPA observation, licensee did not store medication where it was inaccessible to 2 of 2 clients in care. This posed a potential health risk for persons in care.
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Type B
06/19/2024
Section Cited
CCR
80070(a)
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Client Records. The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client. This requirement was not met, as evidenced by:
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Staff agreed to ensure that staff who administer medications attend training on recordkeeping. Proof of correction will be provided to Community Care Licensing by the POC due date.
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Based on staff interview, licensee did not maintain a current medication administration record for C1 and C2, 2 of 2 clients in care. This posed a potential health risk for persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 08-AS-20240521113204
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: BIGNELL HOME CARE
FACILITY NUMBER: 370808459
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2024
Section Cited
CCR
80026(h)
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Safeguards for Cash Resources, Personal Property, and Valuables of Residents. (h) Each licensee shall maintain accurate records of accounts of cash resources. . .entrusted to his/her care. . .This requirement was not met as evidenced by:
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LPA observed C1's P&I log to be current during the visit. Staff agreed to ensure that all staff who disburse funds attend training on recordkeeping. Proof of correction will be provided to Community Care Licensing by the POC due date.
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Based on records review and LPA observation, licensee did not maintain accurate records of cash resources for C1, 1 of 2 clients in care. This posed a potential personal rights violation for persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6