374600026-9-30-2022-08-AS-DPOL-CJRSS5-20220930140723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600026
Report Date: 09/30/2022
Date Signed: 09/30/2022 01:35:27 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
08/31/2021 and conducted by Evaluator Liliana Silveira

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20210831094514

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):

1
2
3
4
5
6
7
8
9

-Facility is not servicing the elevator to maintain it operable.
-Residents are served cold meals.
-Facility does not have planned activities for residents.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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 08/31/2021, it was alleged that the facility was not servicing the elevator to maintain it operable. Between 08/23/21 to 08/28/21, and again on 08/31/21, the elevator was inoperable due to servicing. Records review demonstrated that the facility had a contract with an elevator servicing company and made plans with the company to fix the elevator issues. Interviews with staff, residents and outside sources revealed that staff was hired to fix the elevator. Records review and interviews with staff also demonstrated that the elevator was fixed and the facility made reasonable accommodations for residents to mitigate the impact. (continued on LIC 9099C)

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)

Page: 1 of 2

Control Number 08-AS-20210831094514

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

It was also alleged that residents on the second floor were served cold meals when the elevator was out of order. Interviews with staff, residents and outside sources revealed that dining staff did deliver meals to resident’s rooms in Styrofoam containers. A majority of those interviewed indicated that there were no issues with the temperature of the food.

It was also alleged that the facility did not have planned activities for residents. Interviews with staff, residents and outside sources revealed that, while there were staffing issues and cancelation of some activities, activities were still provided for the residents. A records review also demonstrated that an activities calendar was posted and information about the activities was distributed to the residents.

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)

Page: 2 of 2