<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600345
Report Date: 09/27/2023
Date Signed: 09/27/2023 08:45:09 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
06/24/2020 and conducted by Evaluator Rebecca A Ruiz
COMPLAINT CONTROL NUMBER: 08-AS-20200624154250
FACILITY NAME:ATRIA ENCINITAS SOUTHFACILITY NUMBER:
374600345
ADMINISTRATOR:MARTINEZ, USBALDOFACILITY TYPE:
740
ADDRESS:504 S EL CAMINO REALTELEPHONE:
(760) 436-9990
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:0CENSUS: 0DATE:
09/27/2023
UNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:Facility ClosedTIME COMPLETED:
08:09 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not administer medication as prescribed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rebecca Ruiz concluded an investigation regarding the above-mentioned allegation.

The Department’s investigation consisted of interviews with staff and outside sources, records review, and a tour of the facility. It was alleged that facility staff did not administer medication as prescribed. It was alleged that Resident #1 (R1) was not given Medication #1 (M1) according to Physician’s prescription for approximately one month. Review of medical records revealed that M1 was stopped on 4/17/2020. R1’s physician was contacted to restart M1, but physician’s orders were not received by the facility due to a fax error until 5/22/20. Review of facility records revealed that on 5/30/20, a medication cart audit was conducted, and it was noted that a dose of M1 was not provided to R1 on 5/23/2020.

Continued on LIC9099-C page...
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
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-20200624154250
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: ATRIA ENCINITAS SOUTH
FACILITY NUMBER: 374600345
VISIT DATE: 09/27/2023
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
There were no adverse reactions reported. The Department has investigated the allegation that facility staff did not administer medication as prescribed and has found that, based upon evidence found during interviews and record review, the preponderance of the evidence standard has been met. Therefore, this allegation is deemed substantiated.

This deficiency is noted on the attached 9099-D and is cited in accordance with the California Code of Regulations, Title 22. A copy of this report, along with Licensee/Appeal Rights, were mailed to the licensee’s last known address on file via USPS Certified Mail.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 08-AS-20200624154250
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: ATRIA ENCINITAS SOUTH
FACILITY NUMBER: 374600345
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2023
Section Cited
CCR
87465(a)(4)
1
2
3
4
5
6
7
Incidental Medical and Dental Care
87465(a)(4) - The licensee shall assist residents with self-administered medications as needed.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
POC cleared as evidenced by facility closure.
8
9
10
11
12
13
14
Based upon interviews and record review, the licensee did not assist 1 of 47 residents (R1) with a self-administered medication as needed. This posed a potential health risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
LIC9099 (FAS) - (06/04)
Page: 3 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
06/24/2020 and conducted by Evaluator Rebecca A Ruiz
COMPLAINT CONTROL NUMBER: 08-AS-20200624154250

FACILITY NAME:ATRIA ENCINITAS SOUTHFACILITY NUMBER:
374600345
ADMINISTRATOR:MARTINEZ, USBALDOFACILITY TYPE:
740
ADDRESS:504 S EL CAMINO REALTELEPHONE:
(760) 436-9990
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:0CENSUS: 0DATE:
09/27/2023
UNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:Facility ClosedTIME COMPLETED:
08:09 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Neglect/Lack of supervision resulted in resident sustaining injury due to a fall
Facility did not obtain timely medical care for resident
Unlawful eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rebecca Ruiz concluded a complaint investigation.

The Department’s investigation consisted of interviews with staff and outside sources, records review, and a tour of the facility. It was alleged that Neglect/Lack of Care and Supervision resulted in Resident 1 (R1) sustaining injury due to a fall. Review of facility records revealed R1 was admitted to the facility on 4/30/2018. R1 was diagnosed with mild cognitive impairment, was ambulatory, and ambulated with the aid of a walker. Staff observed R1 to ambulate with ease. R1 was able to communicate their needs and follow instructions. Record review and interviews revealed that on 4/08/2020, R1 was found on the floor of their apartment. R1 was able to explain that they were reaching for an item on the floor and lost their balance. R1 complained of dizziness and being light-headed. Facility staff called 911 and R1 was taken to a hospital for evaluation.

Continued on LIC9099-C page...
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 08-AS-20200624154250
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: ATRIA ENCINITAS SOUTH
FACILITY NUMBER: 374600345
VISIT DATE: 09/27/2023
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
Medical professionals evaluated R1 and found that R1 had suffered a small subdural hemorrhage. Review of medical records revealed that R1 recounted prior falls and displayed confusion regarding the time frames of these falls. An updated medical assessment revealed R1 had been diagnosed with major neuro-cognitive disorder. Review of facility records revealed R1 was identified as a fall risk and facility staff advised R1 about fall mitigation to prevent falls. R1 was advised to use their pendant to call for help if needed and keep their walker nearby. Physical Therapy and Occupational Therapy were also sought to assist R1. R1 had experienced a total of six falls since admission to the facility, with two occurring outside the facility. There were no serious injuries reported and R1 received reappraisals after the falls. R1’s care plan noted status checks to be conducted nine times a day and interviews with staff revealed that staff checked on fall risk residents every 2 hours. R1 returned to the facility with new medication orders and updated diagnosis. Interviews with staff were not able to confirm when R1 was last seen prior to their fall on 4/08/2020.

It was alleged that facility staff did not obtain timely medical care for R1. Interviews revealed that R1’s family believed that R1’s fall on 4/08/2020 had occurred two weeks prior. Review of R1’s medical records and facility records revealed that R1 had only fallen once in 2020 on 4/08/2020 and R1’s last fall prior to 2020 was reported on 7/24/2019. During R1’s fall on 4/08/2020, facility staff contacted 911 shortly after R1 reported falling and R1 was transported to the hospital the same day. The investigation did not reveal any evidence that R1 had fallen in the two weeks prior to the fall on 4/08/2020.

It was alleged that R1 was unlawfully evicted. Review of records revealed that on May 22, 2020, facility staff served R1 with a 30-day eviction notice. The reason for the eviction noted that the facility was no longer the appropriate setting for R1 and noted that facility staff were unable to meet R1’s needs due to R1’s confusion and attempts to exit the community. Review of R1's medical records revealed that upon return from a hospital on or about April 2020, R1 was diagnosed with a major neuro-cognitive disorder. Interviews also revealed that R1 was noted with increased confusion. In April 2020, a reappraisal was completed for R1.

Continued on LIC9099-C page...
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 08-AS-20200624154250
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: ATRIA ENCINITAS SOUTH
FACILITY NUMBER: 374600345
VISIT DATE: 09/27/2023
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
On May 19, 2020, a caregiver was placed with R1 for their safety. Interviews with staff and outside sources yielded conflicting statements regarding R1's diagnosis. Records reviewed, including medical assessments, confirmed that R1 was diagnosed with a major neuro-cognitive disorder, and that there were instances of observed confusion and exit-seeking behavior.

This Department has investigated the above-mentioned allegations and based upon interviews and record review, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated.

A copy of this report, along with Licensee/Appeal Rights, were mailed to the licensee’s last known address on file via USPS Certified Mail.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6