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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600872
Report Date: 09/26/2023
Date Signed: 09/26/2023 01:31:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
11/04/2022 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20221104082006
FACILITY NAME:OCEAN VIEW HOMES IIIFACILITY NUMBER:
374600872
ADMINISTRATOR:ALICIA MILLANFACILITY TYPE:
740
ADDRESS:6602 AVENIDA MIROLATELEPHONE:
(858) 551-2736
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY:6CENSUS: 3DATE:
09/26/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Alicia MillanTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Staff handled resident roughly resulting in injury
Licensee retained a resident with a prohibited health condition
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to deliver findings. The LPA introduced himself and disclosed the purpose of the visit to Administrator Alicia Millan

Throughout the investigation, the Department secured pertinent records and conducted interviews with staff, residents and external sources.

It was alleged staff handled a resident roughly resulting in injury. It was reported to the Department Staff # 1 (S1) provided unnecessary and aggressive skin care to Resident # 1 (R1). R1 was diagnosed with T-cell Lymphoma which caused dry skin. Interviews with internal and external sources confirmed S1 had provided skin care to R1. An external source revealed this was communicated with R1's primary care physician, who reported the care should have not been provided. An additional external source revealed skin care should have only been provided by someone trained to provide such care, and that R1’s hospice care plan indicated hospice staff would perform skin care, not facility staff.
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
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 6
Control Number 08-AS-20221104082006
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: OCEAN VIEW HOMES III
FACILITY NUMBER: 374600872
VISIT DATE: 09/26/2023
NARRATIVE
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It was alleged the licensee retained a resident with a prohibited health condition. It was reported to the Department R1 was discharged from the hospital to the facility with a Gastrostomy tube. Review of incident report, and interviews with internal and external sources corroborated R1 had a Gastrostomy tube while at the facility. Review of the Department’s Field Automation System (FAS) revealed there was no exception request for the prohibited health condition. Additionally, interviews and review of documents revealed hospice services were not initiated until a later date.

Based on evidence obtained throughout the investigation, the allegations were Substantiated. The deficiencies were cited in accordance with California Code of Regulations, Title 22, and listed on the LIC 9099D. A plan of correction was jointly formulated with Administrator Alicia Millan.

An exit interview was conducted with Millan , to whom a copy of this report, LIC 9099D, LIC 811 and Licensee/Appeals Rights (LIC 9058) were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
11/04/2022 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20221104082006

FACILITY NAME:OCEAN VIEW HOMES IIIFACILITY NUMBER:
374600872
ADMINISTRATOR:ALICIA MILLANFACILITY TYPE:
740
ADDRESS:6602 AVENIDA MIROLATELEPHONE:
(858) 551-2736
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY:6CENSUS: 3DATE:
09/26/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Alicia MillanTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Neglect resulting in resident sustaining injury
Licensee did not assist resident with medication as prescribed
Staff did not treat resident with dignity
Staff are not able to communicate with residents
Staff did not protect resident's personal property
Staff used resident's room for storage
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to deliver complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Administrator Alicia Millan.

Throughout the investigation, the Department secured pertinent records and conducted interviews with staff, residents and external sources.

It was alleged neglect resulted in Resident # 1(R1) sustaining an injury. It was reported to the Department a staff member had dropped R1 while providing care. This allegedly resulted in R1 going to the hospital and sustaining a bruise to the arm. Interviews with internal and external sources revealed conflicting statements on whether the incident occurred and how R1 sustained the bruises. Review of pertinent documents at the facility did not reveal any similar incidents, and although photographs of the bruises were submitted to the Department, there was not a preponderance of evidence to prove the alleged violation occurred.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 08-AS-20221104082006
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: OCEAN VIEW HOMES III
FACILITY NUMBER: 374600872
VISIT DATE: 09/26/2023
NARRATIVE
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It was alleged staff did not assist a resident with medication as prescribed. It was reported to the Department there were concerns regarding the facility assisting the resident with medication management. Interviews with internal and external sources did not reveal any concerns with staff not assisting the R1, or other residents with medication management.

It was alleged staff were not able to communicate with residents. It was reported to the Department staff may have a language barrier preventing them form properly communicating with residents. Interviews with internal and external sources revealed conflicting statements regarding staff being able to communicate with residents. Interviews and observations of staff revealed two of three staff were able to communicate and assist the residents in care. One staff did not speak the residents’ language fluently but was able to communicate verbally and meet the residents’ needs. An interview with the administrator revealed the administrator had identified the staff in question and required additional assistance from other staff, and would not be scheduled to work without other staff present.

It was alleged the facility did not protect R1’s personal property. It was reported to the Department R1’s vehicle was damaged after the facility painted a fence and did not move the vehicle causing paint damage. Interviews with internal and external sources confirmed the vehicle was parked in the driveway and had become damage after the facility sprayed painted an adjacent fence. Interviews also revealed conflicting statements on where the vehicle could be parked, who had access to the vehicle and who was responsible for the vehicle.

It was alleged the facility used a resident’s room for storage. It was reported to the Department the facility would used R1’s bathroom to store facility items. Observations along with interviews with internal and external sources revealed R1’s bathroom was used to store R1’s care products and facility products used to assist all residents in care. There were conflicting statements regarding if this was agreed upon with the R1 and R1's responsible party.An observation of another resident’s room and interview of that resident revealed the resident had agreed to store items in the room for staff. Per observation, the resident had space to ambulate through the room.

It was alleged staff did not treat resident with dignity. It was reported to the Department a staff had yelled at R1. Interviews with internal and external sources did not reveal any concerns regarding the facility staff yelling at residents in care.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 08-AS-20221104082006
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: OCEAN VIEW HOMES III
FACILITY NUMBER: 374600872
VISIT DATE: 09/26/2023
NARRATIVE
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An exit interview was conducted with Millan, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058) were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 08-AS-20221104082006
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: OCEAN VIEW HOMES III
FACILITY NUMBER: 374600872
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/26/2023
Section Cited
CCR
87615(a)(2)
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87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly:(2) Gastrostomy tubes. This requirement was not met as evidenced by:
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Resident is no longer residing at the facility. Plan of corection cleared on todays date.
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Based on interviews and review of records, the Licensee did not ensure the facility did not retain a resident (R1) with a prohibited health condition, which posed an immediate health, safety and personal rights risk to 1 0f 3 residents in care.
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Type B
09/26/2023
Section Cited
CCR
87468.2(a)(8)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evidenced by:
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Administrator agreed to provide in service training to all staff regarding personal rights. Administrator will submit proof of completed training by 10/25/23.
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Based on interviews, and review of records, the Licensee did not ensure R1 was free of neglect which resulted in an pontentail helath, safety, and personal rights risk to 1 of 3 residents 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) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6