374600488-12-19-2022-08-AS-LTEZ-CMJN8M-20221228091431

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600488
Report Date: 12/19/2022
Date Signed: 12/19/2022 10:44:10 AM

Unsubstantiated

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
03/01/2022 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20220301165708

FACILITY NAME:	CASA DE LAS CAMPANAS		FACILITY NUMBER:	374600488
ADMINISTRATOR:	KIMBERLY FINCH-DOMINY		FACILITY TYPE:	741
ADDRESS:	18655 WEST BERNARDO DRIVE		TELEPHONE:	(858) 451-9152
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92127
CAPACITY:	582	CENSUS: 465	DATE:	12/19/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Director of Resident Services Monica Furguiele		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Licensee did not safeguard resident from financial abuse.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by and identified himself to Receptionist Rosalia Gomez. LPA then met with and discussed the purpose of the visit with Director of Resident Services Monica Furgiuele.

It was alleged around August and September 2021, Resident #1 (R1) was being financially abused by Resident #2 (R2), and that license did not safeguard R1 from R2. CCLD’s investigation involved an unannounced facility tour, review of R1’s care and administrative records, and interviews of R1 and pertinent staff and outside sources.

[CONTINUED ON LIC 9099-C, 1 of 2]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

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-20220301165708

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: CASA DE LAS CAMPANAS	FACILITY NUMBER: 374600488
	VISIT DATE: 12/19/2022

NARRATIVE

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[CONTINUED FROM LIC 9099]

According to R1’s Face Sheet and Admissions Agreement contract, they moved into the facility’s “Independent Living” section in 2013 as their own responsible and financial party, where they remained throughout the complaint investigation. Per their initial LIC603A Resident Appraisal in July 2013, R1’s mental condition was rated as “Excellent – Active Mentally.” According to R1’s May 2013 LIC602 Physician’s Report, R1 had no sign of cognitive impairment, confusion, or disorientation. R1 was independent with personal care and medications, and was “able to manage own cash resources,” “able to follow instructions,” “able to communicate needs,” and “able to leave the facility unassisted.” Each of these features was reiterated / remained true on R1’s subsequent June 2021 LIC602 Physician’s Report, completed just a few months before the time frame of the complaint allegation. R1’s ongoing cognitive and functional independence was also corroborated in licensee’s 2020 reappraisal of R1.

CCLD interviewed R1, finding them fully alert, oriented, articulate, and credible. R1 described R2 as a romantic companion who was supportive of them, “very kind,” and “a wonderful person.” R1 said R2 has never tried to steal money from them, coerced them to make any purchase, or taken control of their property against their will. CCLD also interviewed a credible outside source (P1), who corroborated that there were no unauthorized withdrawals from R1’s bank accounts. R1 repeatedly told P1 they were “in love” with R1, and that R1 never took advantage of them. P1 said facility manager Staff #1 (S1) interviewed and performed a cognitive reassessment of R1, finding no indications or suspicions of financial abuse. P1 said S1 was “very responsive” and “very helpful.”

CCLD interviewed S1, who said upon learning of initial claims of financial abuse between S1 and S2, they reported it to San Diego County Adult Protective Services (APS) and the San Diego County Long Term Care Ombudsman Program office (LTCOP). S1 interviewed R1 and R2 separately, and then together, and found no indication that financial abuse had occurred. S1 said they performed a cognitive re-evaluation of R1, which showed R1 remained cognitively competent. CCLD obtained a copy of the St. Louis University Mental Status Examination (SLUMS) diagnostic tool which S1 used on R1. It showed that on 09/09/2021, R1 scored 29 out of a possible 30 points, which was within the tool’s “normal” range.

[CONTINUED ON LIC 9099-C, 2 of 2]

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20220301165708

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: CASA DE LAS CAMPANAS	FACILITY NUMBER: 374600488
	VISIT DATE: 12/19/2022

NARRATIVE

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[CONTINUED FROM LIC 9099-C, 1 of 2]

CCLD also consulted with APS, which independently investigated the matter, determining R1 was cognitively competent. APS said they closed their investigation after finding no indication that financial abuse occurred between R1 and R2.

Based on interviews and records, there does not exist a preponderance of evidence showing R2 financially abused R1. Rather, the evidence shows Licensee safeguarded R1 by reporting and investigating the matter. The allegation is therefore unsubstantiated. An exit interview was conducted with Furgiuele, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

LIC9099 (FAS) - (06/04)

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