374601999-12-27-2023-08-AS-JLOT-CZMUWN-20240119145701

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601999
Report Date: 12/27/2023
Date Signed: 12/27/2023 02:52:21 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
01/13/2023 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230113081334

FACILITY NAME:	LA COSTA GOLF RCFE		FACILITY NUMBER:	374601999
ADMINISTRATOR:	JASNA POPOVICH		FACILITY TYPE:	740
ADDRESS:	2702 LA COSTA AVE		TELEPHONE:	(760) 944-1900
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92009
CAPACITY:	6	CENSUS: 5	DATE:	12/27/2023
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Administrator David Swagerty		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff handled resident(s) in a rough manner.
Staff did not meet resident(s) needs.
Staff did not meet resident(s) incontinence needs.
Staff did not administer medication as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Administrator David Swagerty.

On 1/13/23 it was alleged that staff handled resident(s) in a rough manner, staff did not meet resident(s) needs, staff did not met resident(s) incontinence needs, and staff did not administer medication as prescribed. The Department’s investigation consisted of unannounced facility visits, review of facility and outside source records, interviews with facility staff, residents, outside sources, and LPA direct observations.

Regarding the allegation, "Staff handled resident(s) in a rough manner", staff interviews did not corroborate the allegation; all staff members denied observing any staff handling a resident in a rough manner. Resident interviews did not corroborate the allegation, residents interviewed did not express concern regarding their physical interactions with staff.
(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

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-20230113081334

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: LA COSTA GOLF RCFE	FACILITY NUMBER: 374601999
	VISIT DATE: 12/27/2023

NARRATIVE

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(Continued from LIC9099)

Outside sources interviewed did not corroborate the allegation, expressing no concerns in their observations of staff physically assisting residents, and not being informed by residents of rough handling concerns. Outside sources indicated that the language barrier and cultural miscommunications have resulted in misunderstandings. No records were found to support the allegation. The resident in question was unable to be interviewed.

Regarding the allegation, "Staff did not meet resident(s) needs", it was alleged that staff did not respond to resident(s) call and/or provide assistance when needed. Staff interviews revealed that staff respond timely and frequently to resident requests and needs. Residents interviewed informed that staff assist them with their needs and respond when called. Outside source interviews were mixed, some sources stated they had no concerns, and other sources expressed concern regarding staff assistance during the night and follow through for therapies. No records were found to support the allegation. During three (3) unannounced facility visits, LPA directly observed staff members assisting residents when they heard the residents call out for assistance. LPA observed that staff did not always hear the residents call out every time, but once the call was heard, staff assisted within minutes. LPA spoke with the Administrators regarding how to ensure residents were heard on the first call. The resident in question was unable to be interviewed.

Regarding the allegation, "Staff did not meet resident(s) incontinence needs", it was alleged that staff allowed resident(s) to remain in soiled briefs for long periods of time and double-diapered them. Staff interviews did not corroborate the allegation, staff informed that residents were changed 5-10 times per day, depending on individual needs and requests. Staff interview further revealed that for certain residents with more significant incontinence issues, an additional bed pad was used in the form of a second brief cut on the sides and laid flat on top of the bed. Resident interviews did not corroborate the allegation, residents stated they were assisted by staff with toileting and upon request. Outside source interviews confirmed observing that some residents were provided a second brief for incontinent issues, but noted that it was not done to keep staff from providing incontinence duties. Outside source interview further revealed observations of residents being clean and dry during facility visits, and residents being checked for incontinence throughout the day. No records were found to support the allegation. During three (3) unannounced facility visits LPA observed staff members assisting residents with toileting throughout the day; LPA observed the facility to be free from incontinence odors. The resident in question was unable to be interviewed.
(Continued on LIC9099-C)

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230113081334

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: LA COSTA GOLF RCFE	FACILITY NUMBER: 374601999
	VISIT DATE: 12/27/2023

NARRATIVE

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(Continued from LIC9099-C)

Regarding the allegation, "Staff did not administer medication as prescribed", it was alleged that staff administered a pro re nata (PRN) medication to a resident (R1) at intervals more frequent than the prescription allowed. Staff interviews did not corroborate the allegation, staff denied that PRNs were provided more frequently than the prescription, as the medications were audited by management weekly with no errors having been noted. Residents interviewed stated that they received their medications timely and correctly from staff. Outside source interviews did not reveal concerns regarding medication administration. Outside source interviews further revealed that the medication was prescribed to the resident and was administered within the prescription requirements. No records were found to corroborate the allegation. The resident in question was not able to be interviewed.

Based on interviews, direct LPA observations and records review, the investigation did not yield sufficient evidence to conclude that the alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. This finding means that although the allegations may have happened or may be valid, there is not a preponderance of the evidence to prove that they occurred. An exit interview was conducted with Administrator David Swagerty, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

LIC9099 (FAS) - (06/04)

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