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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602248
Report Date: 07/16/2024
Date Signed: 07/16/2024 03:27:02 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
09/22/2022 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20220922161921
FACILITY NAME:LUCY'S HOMEFACILITY NUMBER:
374602248
ADMINISTRATOR:LUCY ANTHONYFACILITY TYPE:
735
ADDRESS:4979 GOLF GLEN ROADTELEPHONE:
(619) 267-7244
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY:4CENSUS: 4DATE:
07/16/2024
UNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:AdministratorTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff did not clean/disinfect client’s reusable medical equipment
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to follow up, conduct additional interviews, and deliver investigative findings. LPA met with Administrator, Lucy Anthony, and shared findings.

The Department investigated the above-listed complaint allegation. The investigation consisted of an inspection of the facility, observations, multiple interviews with clients, staff, and outside sources, and a detailed review of relevant records.

On September 22, 2022, Community Care Licensing (CCL) received a complaint alleging that staff did not clean/disinfect the client’s (C1), [a LIC811 Confidential Name List was provided to staff to identify C1], reusable medical equipment. It was specifically alleged that on or about September 10, 2022, C1’s CPAP (continuous positive airway pressure) device was observed dirty with black mold.
(continue at LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
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 5
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
09/22/2022 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20220922161921

FACILITY NAME:LUCY'S HOMEFACILITY NUMBER:
374602248
ADMINISTRATOR:LUCY ANTHONYFACILITY TYPE:
735
ADDRESS:4979 GOLF GLEN ROADTELEPHONE:
(619) 267-7244
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY:4CENSUS: 4DATE:
07/16/2024
UNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:AdministratorTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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9
Staff did not meet client’s medical needs
Staff did not allow client to leave the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to deliver investigative findings. LPA was greeted by House Manager Jose Lopez. LPA spoke and delivered findings with Administrator, Lucy Anthony.

The Department investigated the above-listed complaint allegations. The investigation consisted of observations, a review of relevant records, and interviews with facility staff, clients, and outside sources.

On September 22, 2022, Community Care Licensing (CCL) received a complaint alleging that staff did not meet Client’s (C1) medical needs, [a LIC811 Confidential Name List was provided to staff to identify C1]. It was specifically alleged that on or about September 10, 2022, C1 was observed with puss coming out of a sore on the side of her head and that staff did not seek timely medical attention to meet C1’s needs.

(continue at LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20220922161921
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: LUCY'S HOME
FACILITY NUMBER: 374602248
VISIT DATE: 07/16/2024
NARRATIVE
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(continue from LIC9099)

During multiple interviews, staff stated that C1 had a dry scalp condition that was treated with over-the-counter shampoo per doctor’s orders. During an interview, C1 stated that at times they get a facial rash (rosacea) because they use a CPAP (continuous positive airway pressure) mask. During the same interview, C1 denied having any other type of skin infection on their face or any other parts of their body. A review of C1’s medical records indicated that C1 had a doctor’s order for a clotrimazole cream to treat the skin rash. A review of C1’s medication administrative records indicated that staff administered the medicated cream as ordered. During a visit conducted on September 27, 2022, C1 was observed with no signs of an infection on their scalp or any other visible part of their body.

It was also alleged that staff did not allow C1 to leave the facility. It was specifically alleged that staff did not allow C1 to go on an out-of-state vacation. During multiple interviews with staff and outside sources, it was consistently stated that C1 refused to go on the said vacation. During an interview, C1 confirmed that it was their decision not to go on vacation.

The Department has investigated the above-mentioned allegations and based on interviews with staff, clients, and outside sources and records review, the preponderance of the evidence has not been met, therefore, these allegations are deemed to be unsubstantiated.

An exit interview was conducted with Administrator, Anthony to whom a copy of this report, LIC811 Confidential Name List, and the Licensee Appeal Rights (LIC9058 03/23), were provided at the conclusion of the visit.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20220922161921
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: LUCY'S HOME
FACILITY NUMBER: 374602248
VISIT DATE: 07/16/2024
NARRATIVE
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(continue from LIC9099)

A review of C1’s medical records indicated that C1 had a physician’s order for a CPAP due to C1’s severe obstructive sleep apnea condition. The CPAP mask was to be used at all times while C1 was sleeping. During a visit on September 27, 2022, the CPAP mask and hoses were observed to be dirty with mold. Interviews with staff indicated that C1 routinely cleaned the device with no staff assistance. Staff stated that C1 did not allow staff to touch their device. During an interview, C1 confirmed that they did not like anybody touching their device. Staff agreed to provide the supervision and assistance required to ensure C1’s CPAP device was cleaned and disinfected daily to meet C1’s care needs.

The Department has investigated the above-mentioned allegation and has found that there was sufficient evidence to corroborate the allegation. Therefore, this allegation is deemed to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. A Deficiency was cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on LIC 9099-D. A plan of correction was developed with Administrator, Anthony, on September 27, 2022. During today’s visit, the plan of correction was verified no additional follow-up is warranted at this time.

A copy of this report, LIC 9099D, LIC811 Confidential name list along with Licensee/Appeal Rights (LIC 9058 03/22) was provided to Administrator, Lucy Anthony at the end of the visit.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20220922161921
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: LUCY'S HOME
FACILITY NUMBER: 374602248
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/16/2024
Section Cited
CCR
80092.1(b)
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80092.1 General Requirements for restricted health conditions (b) The licensee is willing to provide the needed care. This requirement was not met as evidenced by:
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A plan of corrections was completed during this investigation. On September 27, 2022, the licensee agreed to provide additional training to staff on the general requirements for restricted health conditions. The licensee agreed to provide proper care and supervision as needed to ensure C1’s inhalation-assistive device is maintained clean and disinfected to meet C1’s care needs. Plan of Correction is complete.
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Based on observations and interviews with staff and clients it was disclosed that the licensee did not provide the needed care to properly maintain C1’s inhalation-assistive device. This posed potential health risks to one (1) of four (4) clients in care.
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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.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5