374602052-5-30-2023-08-AS-SJAB-CSCVG3-20230531162451

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602052
Report Date: 05/30/2023
Date Signed: 05/30/2023 02:14:27 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
03/16/2022 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20220316085001

FACILITY NAME:	OLIVENHAIN GUEST HOME		FACILITY NUMBER:	374602052
ADMINISTRATOR:	KAREN KANAN		FACILITY TYPE:	740
ADDRESS:	350 COLE RANCH ROAD		TELEPHONE:	(760) 753-5082
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	0	CENSUS:	DATE:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Report mailed to former licensee via USPS Certified Mail		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff pushed resident
Staff are not responding to call bell
Staff interacted with resident in an inappropriate manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano sent this report to the former licensee at their last known mailing address via USPS certified mail and via email to deliver the investigation findings for the above allegations. The facility ceased operations on or about September 23, 2022.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of LPA direct observation, records review and interviews with facility staff, resident and outside agency.

It was reported to CCL that staff pushed Resident 1 (R1) [an LIC 811 Confidential Names List was provided to the facility representative to identify the residents.] It was also reported that staff interacted with resident in an inappropriate manner and staff did not respond to call bell. Interview with staff on May 25, 2023 revealed they worked directly with R1 during their seven month employment at the facility. Staff stated that R1 was always in their room and never wanted to participate in any activities. Staff further stated that they never witnessed or heard of any staff member pushing or interacting with R1 in an inappropriate manner.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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-20220316085001

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: OLIVENHAIN GUEST HOME	FACILITY NUMBER: 374602052
	VISIT DATE: 05/30/2023

NARRATIVE

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Staff further stated that due to the small size of the facility their were no call bells since the residents were continuously checked on.

LPA visit to the facility on March 23, 2022 found R1 in a clean and well kempt state. R1 was eating in the dining room and appeared confused while repeatedly asking the Licensee of the facility "who are you?" LPA attempted to interview R1 but immediately ended the interview after R1 appeared upset and agitated.

Outside agency interview revealed no knowledge of any staff pushing R1 or treating them in an inappropriate manner. Outside agency stated that R1's responsible party (RP) was regularly at the facility and never mentioned any issues with the staff or the facility. Outside agency further stated that R1's RP advised them that they wanted to move R1 to a facility with higher functioning residents since R1 was having a very hard time adjusting to living in a senior care facility.

Interview with responsible party (RP) on May 19, 2023 revealed R1 initially had a difficult time adjusting to living at the facility since prior to that they were living independently in a mobile home. RP stated that they visited R1 daily and did not witness any abuse firsthand. RP stated that R1 was ambulatory and would move throughout the facility. RP further stated that R1 would call staff on R1's personal phone if R1 needed anything.

Interview with Administrator on May 18, 2023 revealed that at the beginning of R1's stay at the facility R1 did not like to socialize and would stay in their room day and night. Administrator stated that the facility had several Spanish speaking staff members that would verbally redirect R1 on occasion but R1 was never pushed or physically abused by any staff at the facility. Administrator stated that R1 would receive visits from their RP regularly and would also receive outside agency visits twice a week. Administrator stated that she never received any complaints against staff from RP or any outside agency.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid.

A copy of this report along with Licensee/Appeal Rights (LIC 9058) was mailed via USPS Certified Mail to the former licensee’s mailing address on file.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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