374600872-7-14-2021-08-AS-JRAE-C5FR53-20210731124228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600872
Report Date: 07/14/2021
Date Signed: 07/14/2021 12:39:36 PM

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
09/26/2019 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20190926140405

FACILITY NAME:	OCEAN VIEW HOMES III		FACILITY NUMBER:	374600872
ADMINISTRATOR:	ALICIA MILLAN		FACILITY TYPE:	740
ADDRESS:	6602 AVENIDA MIROLA		TELEPHONE:	(858) 551-2736
CITY:	LA JOLLA	STATE: CA	ZIP CODE:	92037
CAPACITY:	6	CENSUS: 6	DATE:	07/14/2021
		UNANNOUNCED	TIME BEGAN:	10:44 AM
MET WITH:	Alicia Millan, Administrator		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

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Facility staff failed to administer residents' medication as prescribed
Facility staff failed to meet the resident's needs
Staff prohibited resident from using hospice agency of their choice.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Tiffany Holmes made an unannounced complaint visit to deliver findings. LPA was granted access to the facility by staff, identified herself, and disclosed the purpose of the visit to Administrator, Alicia Millan.

LPA previously conducted interviews, made observations, and obtained and reviewed pertinent records. The initial visit on September 30, 2019, included a tour of the facility and a review of records. It was alleged facility staff failed to administer residents' medication as prescribed. Interviews revealed that Staff 1 (S1) provided Resident 1 (R1) (see LIC811 Confidential Names List) their medications. The hospice nurse for Light Bridge also provided medications for R1. Interviews revealed that staff at the facility were hesitant to provide certain medications to R1 in the beginning. The staff were educated and coached on the proper way to administer the medications and they continued to provide the medications to R1. Interviews did not reveal staff failed to administer residents' medication as prescribed.

Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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-20190926140405

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: OCEAN VIEW HOMES III	FACILITY NUMBER: 374600872
	VISIT DATE: 07/14/2021

NARRATIVE

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It was alleged facility staff failed to meet the resident's needs. Interviews revealed the staff did not have an issue with preparing food that R1 requested. Interviews revealed staff would ask R1 what they wanted to eat and would make it for R1. Staff would turn R1 regularly due to a bed wound that was being treated by hospice and the staff. Staff and a home health aid would bathe R1. Interviews did not reveal facility staff failed to meet the resident's needs.

It was alleged staff prohibited resident from using hospice agency of their choice. Interviews revealed there were other residents on hospice at the same time R1 was on hospice. Interviews revealed there were other hospice agencies like Seasons Hospice coming to the facility although R1 had already chosen who they were going to deal with. At no time did any other hospice agency provide services for R1 besides the one they chose which was Light Bridge Hospice. Interviews revealed R1 was open to listening to another hospice agency in the beginning to hear what services they were offering but R1 did not waver in their decision for Light Bridge Hospice. Interviews did not reveal staff prohibited resident from using hospice agency of their choice.

Based on interviews conducted, the allegations are unsubstantiated. This agency has investigated the complaint alleging facility staff failed to administer residents' medication as prescribed, facility staff failed to meet the resident's needs and staff prohibited resident from using hospice agency of their choice.

We have found the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations occurred.

An exit interview was conducted and a copy of this report and their appeal rights (LIC9058 01/16) was emailed to the Licensee with an electronic read receipt as confirmation of documents.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC9099 (FAS) - (06/04)

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