374600289-9-1-2022-08-AS-DPOL-CJRRB9-20220930125222

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600289
Report Date: 09/01/2022
Date Signed: 09/01/2022 11:02:14 AM

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
12/11/2020 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20201211142913

FACILITY NAME:	LEMON GROVE TERRACE		FACILITY NUMBER:	374600289
ADMINISTRATOR:	CELIA A. MENESES		FACILITY TYPE:	740
ADDRESS:	8554 CALLE NORTE		TELEPHONE:	(619) 463-6705
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	6	CENSUS: 4	DATE:	09/01/2022
		UNANNOUNCED	TIME BEGAN:	09:37 AM
MET WITH:	Celia A. Meneses, Licensee		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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- Unlawful eviction
- Staff are not providing resident assistance with incontinence care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. LPA introduced herself and was granted entry by Licensee Celia A. Meneses. LPA stated the purpose of the visit and reviewed the findings of the complaint with Licensee Meneses.

The Department’s investigation consisted of interviews with staff and an outside source, and records review of relevant documents pertinent to this investigation. On December 11, 2020, it was alleged Resident #1 (R1) was unlawfully evicted from the facility. It was also alleged staff did not provide R1 with assistance with incontinence care.

Interview with an outside source revealed Licensee wanted responsible party (RP) to move resident R1 out of the facility by December 15, 2020 due to R1 making inappropriate comments to residents and staff.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

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 3

Control Number 08-AS-20201211142913

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: LEMON GROVE TERRACE	FACILITY NUMBER: 374600289
	VISIT DATE: 09/01/2022

NARRATIVE

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Interview with staff #1 (S1) confirmed the facility did not accept R1 back to the facility after R1 was sent to the hospital on April 20, 2021. According to S1, staff believed the resident had a stroke and the facility was not able to care for R1’s higher care needs. R1 was moved out after April 20, 2021 and staff gave R1’s representative a book called New LifeStyles, Guide to Senior Living and Care, which is a book with names of board and cares and nursing homes. In review of resident records, there was no documentation of an eviction notice served to R1 or to R1’s representative, as required.

Interview with an outside source revealed R1 used a unique type of incontinence device which Licensee was aware of prior to R1 being accepted into the facility. Outside source revealed the facility staff was given instructions on how to place the incontinence device and the facility agreed to assist and accepted R1 to the facility. Interview with staff confirmed the facility was aware R1 had a special incontinence device and was instructed how to place the device on R1. Staff opted to use incontinence pads but R1 refused to use the pads and would throw the incontinence pads on the floor. Per staff R1 would purposely remove the device at night and continuously ring the bell for staff assistance until staff entered the room to place the incontinence device back on. Review of resident records showed the facility did not complete records to show R1 needed assistance with incontinence care. During the subsequent visit on August 19, 2022, LPA toured the facility including the current resident’s bedrooms. When LPA entered two out of the five bedrooms, the rooms had a strong odor of urine. LPA observed that one resident had an incontinent device. A review of resident records indicated both residents had incontinence issues and needed additional assistance from staff.

Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff and outside source interviews and records reviewed, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099D.

The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Licensee Celia A. Meneses. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Licensee Meneses at the conclusion of the visit. The signature below confirms receipt of the documents.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20201211142913

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: LEMON GROVE TERRACE	FACILITY NUMBER: 374600289
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/01/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/22/2022 Section Cited CCR 87224(c)	1 2 3 4 5 6 7	87224 Eviction Procedures (c) The licensee shall, in addition to either serving the required thirty (30) days…on the resident, notify or mail a copy of the notice to quit to the resident's responsible person… this requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee will be providing LPA a copy via email of the certificate of completion for eviction training by POC due date, 9/22/2022.
	8 9 10 11 12 13 14	Based on interviews and record reviews, the Licensee did not serve R1 or the RP with an eviction notice. This posed a potential personal rights risk to 1 of 5 of residents in care.	8 9 10 11 12 13 14
Type B 09/22/2022 Section Cited CCR 87625(b)(3)	1 2 3 4 5 6 7	87625 Managed Incontinence (b)… the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee will provide LPA a copy via email of the certificate of completion for incontinence care by POC due date, 9/22/2022.
	8 9 10 11 12 13 14	Based on interviews and records review, the Licensee did not assist incontinent residents to ensure care. This posed a potential health risk to 3 of 5 of residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC9099 (FAS) - (06/04)

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