374600026-9-30-2022-08-AS-DPOL-CJRSUF-20220930141104

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600026
Report Date: 09/30/2022
Date Signed: 09/30/2022 01:27:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/06/2021 and conducted by Evaluator Liliana Silveira

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20211006113833

FACILITY NAME:	SILVERGATE SAN MARCOS RETIREMENT RESIDENCE		FACILITY NUMBER:	374600026
ADMINISTRATOR:	JOAN RINK-CARROLL		FACILITY TYPE:	740
ADDRESS:	1550/1560 SECURITY PLACE		TELEPHONE:	(760) 744-4484
CITY:	SAN MARCOS	STATE: CA	ZIP CODE:	92078
CAPACITY:	160	CENSUS: 138	DATE:	09/30/2022
		UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Executive Director Joan Rink Carroll		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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- Facility did not assist resident with arrangement of transportation services.
- Facility did not follow Admission Agreement.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Liliana Silveira conducted a complaint investigation visit to deliver findings for the above-mentioned allegations. LPA Silveira met with Executive Director Joan Rink-Carroll and shared the findings.

The Department’s investigation consisted of interviews, observations, and records review. On 10/06/2021, it was alleged that the facility did not assist a resident with the arrangement of transportation services. Interviews with staff, residents and outside sources revealed that while changes were made to the transportation schedule effective 10/01/21, the facility continued to facilitate transportation services for the resident in question. Interviews also revealed that assistance with coordinating trips continued to be provided by facility staff. A review of records also demonstrated that transportation services were facilitated by the facility for the resident during this time. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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-20211006113833

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: SILVERGATE SAN MARCOS RETIREMENT RESIDENCE	FACILITY NUMBER: 374600026
	VISIT DATE: 09/30/2022

NARRATIVE

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It was also alleged that the facility did not follow the Admission Agreement. A records review demonstrated that
the information included in the Admission Agreement indicated that transportation services fall under basic services provided. The information in the Admissions Agreement also included that transportation services were provided in accordance with the Transportation Plan. The facility updated the Transportation Plan with a minor change in the selection of days that transportation would be provided for appointments and trips, as well as the implementation of a new mile radius; however, a Transportation Plan was still followed and transportation services continued to be provided.

Due to lack of corroborating evidence, the findings regarding the above allegations were established to be unsubstantiated. This finding means although the allegations may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

LPA Silveira conducted an exit interview with Joan. At the time of the exit interview Joan was provided with a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) and signature on this report acknowledges receipt of the rights.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

LIC9099 (FAS) - (06/04)

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