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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601258
Report Date: 09/09/2024
Date Signed: 09/09/2024 12:51:38 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
08/07/2024 and conducted by Evaluator Rebecca A Ruiz
COMPLAINT CONTROL NUMBER: 08-AS-20240807150113
FACILITY NAME:FAIRWINDS - IVEY RANCHFACILITY NUMBER:
374601258
ADMINISTRATOR:SOMMER, JESSICAFACILITY TYPE:
740
ADDRESS:4490 MESA DRTELEPHONE:
(760) 439-8090
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:200CENSUS: 167DATE:
09/09/2024
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:General Manager Karl MillerTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Food service was not overseen by qualified individual
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to conduct follow up and deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to General Manager Karl Miller.

During today’s visit, LPA observed residents in care, reviewed and obtained copies of facility records, and interviewed staff.

The Department’s investigation consisted of interviews with staff, records review, and a tour of the facility. It was alleged that the food service was not overseen by a qualified individual. Interviews with facility staff revealed that the menu was modified on a quarterly basis and any changes were done with input from the facility chef and cooks, the Restaurant Manager, and the General Manager and was based on resident likes and dislikes, popularity of menu items, and variety to accomodate resident dietary needs.
Continued on LIC9099-D page..
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
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-20240807150113
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: FAIRWINDS - IVEY RANCH
FACILITY NUMBER: 374601258
VISIT DATE: 09/09/2024
NARRATIVE
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Interviews with staff revealed that prior to 2020, the facility’s menu was submitted to the facility’s corporate office for review and assessment once or twice a year. Interviews with facility management revealed that the facility has not provided their corporate office with a sample menu for review since at least 2021. Interviews with staff revealed that neither the Chef or Restaurant Manager are nutritionists, dietitians, or home economists. Review of a nutritional assessment of the facility’s menu revealed that the facility’s menu was reviewed by a dietitian on 8/15/2024. Interviews with facility management revealed that the facility’s menu had not been overseen by a dietitian, nutritionist, or home economist since at least 2018.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency for the facility menu not being overseen by a qualified individual is cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page.

An exit interview was conducted with General Manager Karl Miller, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 08-AS-20240807150113
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: FAIRWINDS - IVEY RANCH
FACILITY NUMBER: 374601258
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2024
Section Cited
CCR
87555(b)(17)
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(b) the following food service requirements shall apply: (17) ... a full-time employee... shall be responsible for the operation of food service. If this person is not a nutritionist, a dietitian, or a home economist, provision shall be made for regular consultation from a person so qualified.
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The General Manager had the facility's menu assessed by a dietitian on 8/15/2024. The General Manager will submit menu changes to a dietitian for review quarterly and will ensure that the menu receives a comprensive assessment at least once a year.
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This requirement has not been met as evidenced by: Based on interviews and records review, the licensee did not ensure that the facility's food service was overseen by a dietitian, nutritionist, or home economist since at least 2021. This poses a potential health risk to 167 of 167 residents in care.
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The General Manager will submit proof of agreement for a dietitian to review the facility's menu on a quarterly basis to the Department by POC due date of 9/23/2024.
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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: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 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
08/07/2024 and conducted by Evaluator Rebecca A Ruiz
COMPLAINT CONTROL NUMBER: 08-AS-20240807150113

FACILITY NAME:FAIRWINDS - IVEY RANCHFACILITY NUMBER:
374601258
ADMINISTRATOR:SOMMER, JESSICAFACILITY TYPE:
740
ADDRESS:4490 MESA DRTELEPHONE:
(760) 439-8090
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:200CENSUS: 167DATE:
09/09/2024
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:General Manager Karl MillerTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Licensee did not meet residents’ dietary needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to conduct follow up and deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to General Manager Karl Miller.

During today’s visit, LPA observed residents in care, reviewed and obtained copies of facility records, and interviewed staff.

The Department’s investigation consisted of interviews with residents and staff, records review, and a tour of the facility. It was alleged that the Licensee did not meet residents’ dietary needs. Interviews with staff and residents and review of the resident roster and physician reports revealed that the facility had multiple residents that have physician ordered modified diets.

Continued on LIC9099-C page...
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 08-AS-20240807150113
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: FAIRWINDS - IVEY RANCH
FACILITY NUMBER: 374601258
VISIT DATE: 09/09/2024
NARRATIVE
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Review of the facility’s prescribed diet order form revealed that residents’ physicians are notified that the facility is only able to accommodate low sodium (GLS), limited concentrated sweets (LSC), and mechanical soft diets.

Review of the facility’s dining room menu for May 2024, healthy items menu, and chef specials menus revealed that the facility offered multiple different meal items using different meats such as beef, pork, chicken, salmon, and turkey as well as a no added sugar dessert options. Review of the facility’s food guide regarding GLS revealed that sodium is restricted on that diet and residents are encouraged to limit the consumption of high salt meats such as ham, sausages, packaged seasoning mixes, soups, sauces, gravies, salad dressing, and marinades. Meals should be made with fresh herbs and soup stocks. Review of the facility’s food guide for LCS revealed that the diet is a liberalized diabetic diet and allows for residents to consume most types of food while following recommended portion sizes, except for desserts. Residents following this diet should be offered diet options of foods such as jelly, syrup, Jell-O, and pudding.

Interviews with staff revealed that in August 2024, the facility began using a new electronic meal ordering system which allowed dining staff to view each resident’s dietary preferences, physician ordered modified diets, and allergies. During a visit on 8/14/2024, LPA Ruiz observed a demonstration of the new electronic ordering system which showed the resident’s name and listed the resident’s dietary preferences, modified diets, and allergies in red text under the resident’s name on an electronic tablet. The system also marked any meals in red if that meal contained ingredients or was prepared in a way that does not align with the resident’s dietary restrictions. Facility staff were able to modify meals by removing or substituting ingredients and placing sauces or dressings on the side. Once the meal has been modified to meet the resident’s dietary restrictions, the meal no longer showed red in the system. The system would print out a ticket in the kitchen that listed the resident’s name, meal order, dietary preferences, modified diets, and allergies in red text. Kitchen staff stated that they often marinate meats for entrees and will set aside a few meats that are not marinated to allow residents with dietary restrictions to order that meal. Staff stated that they are able to make modifications to most meals to allow residents to eat whichever meal the resident chose to eat but stated that there are a few times that the staff could not meet a resident’s request to eat a certain meal. Kitchen staff stated that in that case, staff would speak with the resident to explain the reason that staff cannot accommodate the resident’s dining request and offer alternative meal choices.

Continued on LIC9099-C page…
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 08-AS-20240807150113
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: FAIRWINDS - IVEY RANCH
FACILITY NUMBER: 374601258
VISIT DATE: 09/09/2024
NARRATIVE
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During interviews with dining and kitchen staff, as well as facility management revealed that residents who had a physician ordered modified diet must be willing to follow the requirements of the diet, and staff cannot force residents to choose specific meals or restrict certain meal items. The facility’s prescribed diet order form includes language to physicians that residents must be aware of the physician order diet, must be willing to follow the diet, and that the resident could not be forced to follow the diet. Interviews with dining staff and facility management provided supporting evidence that residents were not required to adhere to the physician ordered diet.

Interviews of residents with modified diets did not reveal any concerns with the meals offered at the facility. Some of the residents interviewed denied that they were following any modified diets while others stated that they were modifying their diet independently without a physician order. Residents did not voice any concerns that the facility did not offer a variety of meals that allowed residents with different meal preferences or requirements to have choices in their meals.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with General Manager Karl Miller, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6