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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602297
Report Date: 05/15/2023
Date Signed: 05/15/2023 05:23:11 PM

Substantiated


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
05/09/2023 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20230509163032
FACILITY NAME:CAREWELL HOME, THEFACILITY NUMBER:
374602297
ADMINISTRATOR:GRACE HEBRONFACILITY TYPE:
735
ADDRESS:3704 SCHIRRA STTELEPHONE:
(619) 423-6470
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY:6CENSUS: 6DATE:
05/15/2023
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator, Grace HebronTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff did not assist client with personal care needs
Staff did not meet client's incontinence needs
Staff left medication accessible to clients
Licensee did not maintain facility clean
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to commence an investigation into the above listed complaint allegations and deliver findings. After introducing herself, LPA was granted entry into the facility by Administrator, Grace Hebron whom she explained the reason for the visit.

Community Care Licensing (CCL) has investigated the above listed allegations. The investigation consisted of a tour of the facility, interview of staff, and review of facility and outside source records.

On May 9, 2023, it was reported to Community Care Licensing (CCL), that the facility staff did not meet client’s (C1) [an LIC 811 Confidential Names List was provided to staff to identify the client] care needs with bathing. It was also alleged that facility staff did not provide toileting products necessary to meet client’s incontinence needs. Additionally, it was alleged medications were not stored in a safe and locked place that was not accessible to clients in care. Lastly, it was alleged the facility was not kept clean and free from malodors.
(Continue on LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
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 4
Control Number 08-AS-20230509163032
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: CAREWELL HOME, THE
FACILITY NUMBER: 374602297
VISIT DATE: 05/15/2023
NARRATIVE
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(Continue from LIC9099)

Based on observations, review of records and staff interviews, the above listed allegations are substantiated. A substantiated finding means that the preponderance of the evidence standard has been met and the allegations are valid. Deficiencies are cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 6 and are noted on the attached LIC 9099-D.

An exit interview was conducted, and plan of corrections was developed with Administrator, Grace Hebron, to whom a copy of this report, LIC9099D, LIC811 Confidential Name list, and a copy of Licensee Appeal Rights (LIC 9058) was provided at the conclusion of the visit.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20230509163032
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: CAREWELL HOME, THE
FACILITY NUMBER: 374602297
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2023
Section Cited
CCR
80077(a)
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85077(a) Personal Services
Licensees shall provide necessary personal assistance and care, with activities of daily living including bathing. This requirement was not met as evidenced by:
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Licensee agreed to conduct in service training for staff on personal services to ensure the personal care needs and personal rights are met for all clients in care. Documentation on in service training will be submitted to CCL by POC date of 6/9/2023.
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Based on observations and interviews the licensee did not provide personal assistance with bathing to C1, which posed a potential personal rights risk to one of six clients in care.
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Type B
06/09/2023
Section Cited
CCR
80077.4(b)(1)
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80077.4(1) Care for Clients with Incontinence
The licensee is responsible for ensuring that incontinent care products are used whenever they are needed. This requirement was not met as evidenced by:
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Licensee agreed to conduct in service training for staff on care for clients with incontinence to ensure the care needs and personal rights are met for all clients in care. Documentation on in service training will be submitted to CCL by POC date of 6/9/2023.
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Based on observations and interviews the licensee did not provide incontinent care products to C1, which posed a potential personal rights risk to one of six 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: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20230509163032
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: CAREWELL HOME, THE
FACILITY NUMBER: 374602297
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2023
Section Cited
CCR
80075
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80075 Health Related Services
Medication shall be kept in a safe and locked place that is not accessible to persons in care. This requirement was not met as evidenced by:
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Licensee agreed to conduct in service training for staff on medication managment. Documentation on in service training will be submitted to CCL by POC date of 6/9/2023.
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Based on observations and interviews the licensee did not keep medication locked, which posed a potential health risk to six of six clients in care.
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Type B
06/09/2023
Section Cited
CCR
80087(a)
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80087(a) Buildings and Grounds
The facility shall be clean, safe, sanitary and in good repair at all times…
This requirement was not met as evidenced by:
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Licensee agreed to conduct in service training for staff to ensure facility is kept clean at all times for the safety of clients in care. Documentation on in service training will be submitted to CCL by POC date of 6/9/2023.
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Based on observations and interviews the licensee did not maintain the facility in good repair for six of six, which posed a potential safety risk to six of six 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: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4