374600916-7-15-2022-08-AS-LTEZ-CGGW2L-20220719165429

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600916
Report Date: 07/14/2022
Date Signed: 07/15/2022 12:04:15 PM

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
10/18/2021 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20211018150950

FACILITY NAME:	ALL FOR SENIORS		FACILITY NUMBER:	374600916
ADMINISTRATOR:	CONSUELO BANTING		FACILITY TYPE:	740
ADDRESS:	10251 TRAILS END CIRCLE		TELEPHONE:	(858) 566-6116
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	6	CENSUS: 6	DATE:	07/14/2022
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Administrator, Connie Banting		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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-Licensee did not provide supervision, resulting in injury
-Resident did not receive medical attention for a dog bite

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to conclude a complaint investigation. LPA identified herself and discussed the allegations mentioned above with Administrator, Connie Banting.

During the investigation, a brief tour the facility was conducted, along with record review, and interviews with staff and outside sources. It was alleged, supervision was not provided for Resident #1 (R1), resulting in injury. It was reported a small dog at the facility bit R1 on the leg. Investigation revealed R1 was scratched on their forearm, not their leg, by the small dog resulting in a skin tear of 1-2 inches in length. Former administrator admitted the small dog belonged to her and was brought to the facility as a therapy dog. Former administrator’s interview revealed the incident occurred in 2018, date unknown. R1 was sitting in their wheelchair and tried to carry the small dog in their lap but the dog did not want to be carried. The small dog accidentally scratched R1 on their forearm, while trying to get away from R1. The former administrator stated she was present when the incident occurred, first aid was applied, and the resident did not require medical attention from the hospital. Continued on an LIC 9099C. This is an amended version of the original report created on 07/14/22.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

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-20211018150950

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: ALL FOR SENIORS	FACILITY NUMBER: 374600916
	VISIT DATE: 07/14/2022

NARRATIVE

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Outside source interviews revealed R1 does not like dogs and was never bitten or scratched. Additional outside source interviews revealed the therapy dogs were hyper and once the incident occurred the dogs were no longer brought back to the facility and the issue was resolved. The current administrator’s interview revealed not being aware R1 was scratched by a dog in the facility. Current administrator stated R1 liked dogs and R1’s family would bring their large dog to the facility with them to visit, which is why the former administrator allowed her small dogs at the facility.

It was alleged, Resident #1 (R1) did not receive medical attention for a dog bite. Outside source and staff interviews confirmed R1 was scratched, not bitten by the dog. As mentioned above the former administrator’s interview revealed the small dog belonged to her and was brought to the facility as therapy dog. The small dog accidentally scratched R1 trying to get away from R1. The scratch resulted in a 1-2 inch skin tear. The former administrator applied first aid along with gauze/bandage was placed on the skin tear. Former administrator also stated within three (3) days the skin tear was resolved, and the resident didn't complain of pain. Outside source interviews revealed witnessing the skin tear on R1 and alerted the staff on duty, who was not aware of the skin tear. The staff cleansed and bandaged the skin tear again. Interviews with outside sources and facility staff, agreed that medical attention was not needed, only first aid, which was applied. Conflicting statements were made regarding the medical attention and first aid. The former administrator stated she applied first aid, but the outside source stated they had to make the staff aware of the skin tear.

Based on interviews conducted the investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. Therefore, the allegations are determined to be unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Administrator, Connie Banting whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

LIC9099 (FAS) - (06/04)

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