372000641-7-20-2023-08-AS-LTEZ-CUA7YJ-20230731220450

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 372000641
Report Date: 07/20/2023
Date Signed: 07/20/2023 04:33:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
03/24/2023 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20230324081605

FACILITY NAME:	WHITE SANDS LA JOLLA		FACILITY NUMBER:	372000641
ADMINISTRATOR:	SMART, SHELLY		FACILITY TYPE:	741
ADDRESS:	7450 OLIVETAS AVE		TELEPHONE:	(858) 454-4201
CITY:	LA JOLLA	STATE: CA	ZIP CODE:	92037
CAPACITY:	299	CENSUS: 245	DATE:	07/20/2023
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Executive Director, Shelly Smart and Assistant Administrator, Venus Jo		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Neglect/ Lack of supervision resulted in a resident sustaining a black eye
Staff did not allow resident to have visitors
Staff did not assist resident with phone calls

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to secured additional records, conduct additional interviews and deliver findings. The LPA introduced himself and disclosed the purpose of the visit to Executive Director, Shelly Smart.

Throughout the investigation, the Department secured pertinent records and conducted interviews with internal and external sources.

It was alleged Neglect/ lack of supervision resulted in a resident sustaining a black eye. It was reported to the Department staff had notified an external source Resident #1 (R1) had sustained a bruise to an eye, but no explanation was provided. Review of records obtained from the facility revealed staff noted R1 had sustained a bruise to R1’s right eye, on March 19th, 2023. Staff assessed R1, who had no complaint of pain and could not recall the incident. On March 20th, 2023, R1 was seen by R1’s primary care physician, who provide care instructions to treat the bruise. (See LIC 9099-C for continuation of report.)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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-20230324081605

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: WHITE SANDS LA JOLLA	FACILITY NUMBER: 372000641
	VISIT DATE: 07/20/2023

NARRATIVE

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Additional records did not reveal any information that would indicate R1 had sustained any recent falls. Interviews with internal and external sources did not reveal any concerns regarding neglect, nor lack of supervision leading to any residents sustaining injuries while in care.

It was alleged staff did not allow a resident to have visitors. It was reported to the Department an external source would not be allowed to enter the facility and in turn had to visit R1 outside of the facility. Interviews with internal and external sources revealed the external source in question had engaged in inappropriate behavior, including verbal altercations with family at the facility and disruptive behavior towards staff and other community members. This behavior had resulted in R1 becoming anxious, agitated and confused. Review of records revealed the external source was provided a written notice to stop the behavior, and a notice the external source was not allowed in the facility, as the behavior had persisted. Although the external source was not allowed in the facility, interviews and records corroborated the facility arranged visits to take place off site.

It was alleged staff did not assist a resident with phone calls. It was reported to the Department staff purposefully would not assist R1 with phone calls, and ignore voice mails. Interviews with internal and external sources did not reveal any concerns regarding lack of assistance with telephone communication. It was revealed R1 had a phone in R1’s room and had received phone calls in the past. Records and interviews corroborated staff had made attempts to contact and return calls when voice mails were left.

Based on the evidence gathered throughout the investigation, there was not a preponderance of evidence to prove the alleged violations occurred, therefore, the allegations were Unsubstantiated.

An exit interview was conducted with Executive Director, Shelly Smart and Assistant Administrator, Venus Jo, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC9099 (FAS) - (06/04)

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