374600488-12-23-2022-08-AS-DPOL-CMKT7X-20221229132927

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600488
Report Date: 12/23/2022
Date Signed: 12/23/2022 11:42:04 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
10/21/2021 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20211021142256

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: 498	DATE:	12/23/2022
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Kimberly F. Dominy, Executive Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

- Facility did not ensure or arrange transportation services.
- Meals are not served in a designated dining area.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Rosalia Gomez, Receptionist. LPA stated the purpose of the visit and reviewed the findings of the complaint with Executive Director, Kimberly Finch Dominy, and Brook Harris, Residential Administrator.

The Department’s investigation consisted of interviews with staff and outside sources, records review of relevant documents pertinent to this investigation, and LPA observations of the facility grounds. On October 21, 2021, it was alleged that the facility did not ensure or arrange transportation services; and the facility did not serve meals in a designated dining area.

Unsubstantiated

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: 12/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2022

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-20211021142256

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: 12/23/2022

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 alleged that the facility did not ensure or arrange transportation services for residents in care. A review of facility records revealed that the facility gave a variety of options for residents to arrange their transportation service. The facility’s transportation service had weekly shopping loops scheduled that included departure and return times and locations. The loop was scheduled for different locations around Rancho Bernardo, Westfield Mall, Escondido, Carmel Mountain, and Poway. On Saturdays and holidays there were no loops scheduled. Additional services the facility provided were medical transportation loops for locations in Rancho Bernardo and Poway. According to their fee schedule and records, residents had the options for a personal driver service available and contact information for Taxi companies if needed. Interview with the Executive Director revealed that their transportation services were fully staffed, and the facility still conducted their daily loops. The facility monitored residents who would use their transportation services to ensure that they were not ill when using their transport service to avoid the spread of any illness. Per the Executive Director, the facility had a contract with a transportation service at a discounted rate for residents if they opted to use those services. According to the Executive Director, the staff assisted residents with uploading the application onto their mobile device and showed residents how to use the application. If the residents needed further assistance, the staff would assist the residents with scheduling their transport service. During a tour of the facility on October 28, 2021, LPA observed Taxi contact information, weekly loop around schedule, Casa Medical Transportation Loop schedule, and fee schedule near the front receptionist desk. Based on the evidence obtained and interview conducted, there is insufficient evidence obtained to indicate that the facility did not assist residents with transportation services.

It was alleged that the facility did not serve meals in a designated dining area. A review of facility records revealed that the designated dining areas had scheduled times that each area were opened and closed. Although dining areas may have been closed, they still served to-go orders. The dining areas did have records that showed that the facility was active in attempting to hire new kitchen and dining staff. Interviews were inconsistent. Interview with an outside source said that the dining areas were closed for a duration between 12 – 18 months. Residents were picking up their meals and having to eat in their rooms.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20211021142256

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: 12/23/2022

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

According to the outside source, the facility had problems with staffing and keeping staff during COVID-19. Once the dining areas became opened, the kitchen area requested for resident volunteers to assist with seating and serving. The dining areas were closed only during their outbreaks November 2020 - January 2021 but resumed their dining services once they were able to in accordance with the State licensing mandates. They did have resident volunteers to assist with packing utensils in the to-go containers and assisted staff with meal deliveries. During a tour of the facility on October 28, 2021, LPA observed that the Bistro and one dining room, in the Assisted Living area, were opened. LPA observed that the menu was posted up at the door of the dining area, inside the dining area, and delivery menus were set out throughout the facility for residents if they opted to eat in their room. In review of facility records and the statements obtained during the interviews, there is not sufficient evidence to indicate that there was not one dining area available for residents to dine in.

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 not sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations is deemed to be unsubstantiated.

The report was discussed, and an exit interview was conducted with Executive Director, Kimberly F. Dominy, and Brook Harris, Resident Administrator. A copy of this report along with Licensee/Appeal Rights (LIC9058 03/22) was provided to Executive Director Dominy at the conclusion of the visit. The signature below confirms the documents were received.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3