374601258-3-1-2023-08-AS-JRAE-CPJV95-20230302151343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601258
Report Date: 03/01/2023
Date Signed: 03/01/2023 12:08:41 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
01/26/2023 and conducted by Evaluator Renita Hall

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230126154728

FACILITY NAME:	FAIRWINDS - IVEY RANCH		FACILITY NUMBER:	374601258
ADMINISTRATOR:	SOMMER, JESSICA		FACILITY TYPE:	740
ADDRESS:	4490 MESA DR		TELEPHONE:	(760) 439-8090
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	200	CENSUS: 157	DATE:	03/01/2023
		UNANNOUNCED	TIME BEGAN:	11:07 AM
MET WITH:	Krista Kiley Sweet, General Manager		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility elevators were in disrepair

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced visit regarding the above-mentioned allegation. LPA were allowed entry by the General Manager. LPA identified herself and disclosed the purpose of the visit and elements of the complaint with the General Manager.

The Department's Investigation consisted of interviews with staff, residents, outside sources and review of records. LPA conducted a tour of the elevators and noticed that the operating certificates had expired 03/2021, and two out three elevators were operatable.

The Department obtained a letter from the Department of Industrial Relations Division of Occupational Safety and Health Elevator Unit stated that passenger elevators #119650, 119649, and 119821 renewal permits to operate were completed and being processed.

Continuance on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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 2

Control Number 08-AS-20230126154728

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: FAIRWINDS - IVEY RANCH	FACILITY NUMBER: 374601258
	VISIT DATE: 03/01/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The elevator located in the main lobby close to the dining area, had a sign posted that stated "out of order." An invoice obtained by the Department dated January 12, 2023 showed how much it would be to replace an existing piston on the elevator and the time frame to complete. The Department obtained a notice dated January 26, 2023 sent to residents that provided an update on the elevator located in the main lobby, which informed residents that a new custom-made part would take 8-10 weeks to be built and installed.

After a tour of the facility elevators were conducted, it was revealed two out of three elevators were functioning for ambulatory and non-ambulatory residents to access. There were also staircases located next to elevators for use.

The Department has investigated the above-mentioned allegation and based on observations, records review, and interviews, the preponderance of the evidence has NOT been met, due to two elevators were functioning and provided access to the first floor to exit building, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with General Manager. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Administrator and his signature on this report confirms receipt of the Licensee Rights.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2