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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600619
Report Date: 12/08/2023
Date Signed: 12/08/2023 12:17:35 PM


Document Has Been Signed on 12/08/2023 12:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:LEICHTAG FAMILY ASSISTED LIVING RESIDENCEFACILITY NUMBER:
374600619
ADMINISTRATOR:CARL MEASERFACILITY TYPE:
740
ADDRESS:211 SAXONY ROADTELEPHONE:
(760) 632-0081
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:77CENSUS: 59DATE:
12/08/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Chief Operations Officer / Administrator Carl MeaserTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced, subsequent Case Management visit to cite a deficiency resulting from an incident self-reported by the licensee. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Chief Operations Officer / Administrator Carl Measer.

On 08/11/2023, the CCLD San Diego Regional Office received an SOC341 Report of Suspected Dependent Adult/Elder Abuse from the licensee. Per the SOC341: on 08/09/2023, Resident #1 (R1) told Staff #1 (S1) they wanted to leave their bedroom and sit in the facility’s lobby. [See LIC811 Confidential Names List for a description of person identifiers used in this report.] S1 tried to stop R1 from doing this, placing hands on R1. This did not cause injury, but it caused R1 to become frightened.

CCLD’s investigation involved a 09/14/2023 facility tour and welfare check, review of pertinent care and administrative records, and interviews of R1 and relevant staff. During today’s visit, LPA again toured the facility and interviewed additional staff.

According to R1’s LIC602 Physician’s Report (dated 12/16/2022): R1 was diagnosed with Mild Cognitive Impairment. Their doctor determined that R1 was not safe to leave the facility unassisted and was “occasionally” confused in the morning, yet R1 remained able to follow instructions and able to communicate their needs. During interview of R1, LPA observed that R1 was vision impaired. R1’s recollection of the incident was coherent, and they were able to be qualified as a credible witness.


[CONTINUED ON LIC 809-C]
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: LEICHTAG FAMILY ASSISTED LIVING RESIDENCE
FACILITY NUMBER: 374600619
VISIT DATE: 12/08/2023
NARRATIVE
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[CONTINUED FROM LIC 809]

Interview of R1, corroborated by multiple staff interviews, showed: During the 08/09/2023 shift, S1 was a contracted home care worker hired by and working under the direction of licensee (rather than working for R1). S1 was therefore acting as one of licensee’s direct care staff. For a brief period of time, S1 repeatedly tried to stop R1 from leaving their bedroom to sit in the facility’s lobby. R1 did not fall and was not injured. R1 said they did not believe S1 was trying to hurt them, but S1’s actions offended and frightened them.

CCLD’s investigation did not conclude that S1’s actions towards R1 rose to the level of willful physical abuse. However, a preponderance of evidence does exist to show that S1 violated R1’s personal rights by not allowing R1 to make a choice concerning their daily life at the facility. One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). A Plan of Correction was jointly developed with the licensee.

An exit interview was conducted with Measer, to whom a copy of this report, the LIC 809-D, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 12/08/2023 12:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: LEICHTAG FAMILY ASSISTED LIVING RESIDENCE
FACILITY NUMBER: 374600619

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/07/2024
Section Cited
CCR
87468.2(a)(6)

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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: “(a)…residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (6) To make choices concerning their daily lives in the facility.”
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Per manager interviews: S1 was suspended from caregiver work in the facility on 08/09/2023 (when the incident came to light). Since then, S1 has not been offered more caregiver work at the facility. Licensee agreed to retrain its larger direct care staff team on Resident’s Personal Rights (as articulated in CCLD form LIC613C-2), and to E-mail a copy of the training sign-in sheet to LPA, by the POC due date.
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This requirement was not met, as evidenced by: Based on records and interviews, during the incident, licensee’s staff (S1) did not allow 1 of 59 residents (R1 to make a choice concerning their daily lives in the facility, which posed a potential personal rights risk to persons in care.
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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: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2023
LIC809 (FAS) - (06/04)
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