374600378-8-12-2021-08-AS-DPOL-CMYUCG-20230111142753

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600378
Report Date: 08/12/2021
Date Signed: 08/12/2021 04:36:26 PM

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
07/16/2020 and conducted by Evaluator Adam Hamer

COMPLAINT CONTROL NUMBER: 08-AS-20200716103459

FACILITY NAME:	CYPRESS COURT ESCONDIDO		FACILITY NUMBER:	374600378
ADMINISTRATOR:	DANIEL-HERR, DONNA		FACILITY TYPE:	740
ADDRESS:	1255 N. BROADWAY		TELEPHONE:	(760) 747-1940
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92026
CAPACITY:	293	CENSUS: 134	DATE:	08/12/2021
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Rob Johnston, Administrator		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Staff did not properly handle food service.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Adam Hamer conducted an unannounced complaint investigation visit at the facility on today's date. LPA identified himself, spoke with Administrator Rob Johnston and discussed the purpose of the visit, which was to deliver the finding for the above allegation.

The Department’s investigation included interviews with staff, the current and former administrator, and residents. Facility records were also obtained by the Department and reviewed for pertinent evidence.

The Department received a complaint on July 16, 2020 alleging that the staff did not properly handle food service - food that was supposed to be served hot was allegedly served cold to residents. Interview with resident (R1)(See Confidential Names List - LIC 811) revealed that during the period when residents were on "lock down" in their rooms

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Adam Hamer	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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-20200716103459

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: CYPRESS COURT ESCONDIDO	FACILITY NUMBER: 374600378
	VISIT DATE: 08/12/2021

NARRATIVE

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due to COVID-19, kitchen staff would serve meals to residents in their rooms. R1 would always get cold food that was supposed to be served hot such as chicken, beef, soups and breakfast foods. R1 complained to staff many times but they continued to be served cold food. Interviews with kitchen staff (S1) revealed that residents constantly complained about being served cold food during this time period. Although efforts were made thereafter to serve the hot food while it was still hot, residents at the far ends of the hallways on each floor would still not be served hot food since it took longer for kitchen staff to get the food to them. Other staff (S2) admitted that this was an ongoing problem with many of the residents throughout the COVID-19 lock down period and that kitchen and other staff were well aware of it.

The Department's review of facility menus during this period revealed that there were many items on the menus for foods that were supposed to be served hot such as scrambled eggs, chicken tortilla soup, beef stew, tarragon chicken, etc. Records review and interviews revealed that the facility did not observe procedures which protected the acceptability of food served to residents until the fall of 2020 when heat boxes and heat plates were purchased to keep the food warm. S1 also admitted during an interview with the Department that many food items that were supposed to be served hot were, in fact, served cold to the residents due to the logistics of the rooms, lack of equipment, and inability of staff to get the food to them quickly.

Based on the evidence obtained during the complaint investigation, the allegation that staff did not properly handle food service is found to be SUBSTANTIATED, as there is a preponderance of the evidence to prove that the allegation occurred. A citation is being issued in accordance with California Code of Regulations, Title 22, and is listed on the attached LIC9099D, and a plan of correction was developed with Mr. Johnston.

An exit interview was conducted with Mr. Johnston, and a copy of this report, the LIC 9099D, the LIC 811 and Applicant/Licensee Rights (LIC 9058 01/16) were emailed to the email address he provided to LPA; he expressed to LPA that he would send a confirmation email to upon receipt of these documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Adam Hamer	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20200716103459

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: CYPRESS COURT ESCONDIDO	FACILITY NUMBER: 374600378
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/12/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/03/2021 Section Cited CCR 87555(b)(9)	1 2 3 4 5 6 7	87555. General Food Service Requirements. (b) The following food service requirements shall apply:(9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service.	1 2 3 4 5 6 7	The Administrator will conduct staff training with kitchen/dining staff on observing procedures for handling and serving hot food to residents. Adminstrator will also purchase any necessary equipment and/or supplies to serve hot food to residents, and provide proof of correction by the POC date.
	8 9 10 11 12 13 14	Based on interviews and records review, facility did not observe procedures to protect the acceptability of food, which posed a potential health risk to 1 out of 150 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: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Adam Hamer	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC9099 (FAS) - (06/04)

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