374601134-1-27-2023-08-AS-JRAE-CNLRBA-20230131115225

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601134
Report Date: 01/27/2023
Date Signed: 01/27/2023 11:52:25 AM

Unfounded

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
01/11/2023 and conducted by Evaluator Iby Strong

COMPLAINT CONTROL NUMBER: 08-AS-20230111082512

FACILITY NAME:	SUNRISE AT LA COSTA		FACILITY NUMBER:	374601134
ADMINISTRATOR:	ERIKA CASTILE		FACILITY TYPE:	740
ADDRESS:	7020 MANZANITA ST		TELEPHONE:	(760) 930-0060
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92008
CAPACITY:	120	CENSUS: 73	DATE:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Resident Care Director Mikhail Grant		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility is not following infection control plan

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings on the above-mentioned allegation. LPA identified herself and discussed the purpose of the visit with Resident Care Director Mikhail Grant.

On January 11th, 2023, Community Care Licensing (CCL) received a complaint alleging facility is not following infection control plan. During investigation, the LPA Strong collected pertinent facility documentation, conducted multiple interviews, and conducted a facility inspection.

According to allegation, on December 26th, 2022, Resident 1 (R1) tested positive for Covid-19 and Resident 2 (R2), who shares a two-bedroom apartment with R1, was not separated to prevent R2 from exposure to infection. During facility inspection on January 17th, 2023, LPA Strong observed all facility staff wearing proper Personal Protective Equipment (PPE) and viewed PPE stations properly placed outside of rooms being monitored for possible infections.
Continue on LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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-20230111082512

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: SUNRISE AT LA COSTA	FACILITY NUMBER: 374601134
	VISIT DATE: 01/27/2023

NARRATIVE

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Continued from LIC9099

Records collected established that facility has been reporting COVID-19 infections to Community Care Licensing and San Diego Public Health. Interview with Resident Care Director revealed that all exposed residents were response tested as required by Provider Information Notice 22-16 Adult and Senior Care. During interviews, Memory Care Coordinator stated that on December 26^th, 2022, R2 was moved to an unoccupied apartment by staff 1(S1). Interview with Resident Care Director corroborated that R2 was moved from infected apartment to an empty room on same date R1 was found to be COVID-19 positive, December 26^th, 2022. Records collected revealed that R2’s responsible party was contacted to attain permission for R2 to be moved into different room. Interview with staff present on the date of the incident corroborated that R2 was moved from exposed apartment to an unoccupied apartment on December 26^th, 2022.

LPA Strong has investigated the complaint alleging facility is not following infection control plan. LPA has found that the complaint was unfounded, meaning that the allegation was false, could not have happened, and/or is without a reasonable basis. LPA has therefore dismissed the complaint. An exit interview was conducted with Resident Care Director Mikhail Grant to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

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