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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602565
Report Date: 12/16/2024
Date Signed: 12/16/2024 01:02:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/01/2023 and conducted by Evaluator Janette Romero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230901085939
FACILITY NAME:AVOCADO CREEKFACILITY NUMBER:
374602565
ADMINISTRATOR:MARIJA BANOVICFACILITY TYPE:
740
ADDRESS:1080 AVOCADO AVETELEPHONE:
(760) 822-5860
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:12CENSUS: 11DATE:
12/16/2024
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Licensee, Marija BanovicTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Night staff do not respond to resident's call for assistance
Staff left resident in soiled diapers for an extended time period
Staff on duty is unable to transfer resident
INVESTIGATION FINDINGS:
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On 12/16/2024, Licensing Program Analyst (LPA), Janette Romero conducted an unannounced visit to deliver findings regarding the allegations listed above. LPA met with Licensee, Marija Banovic who was informed of the purpose of the visit. It was alleged Resident 1 (R1) uses a bell to call for assistance during night hours, but facility staff cannot hear it and do not respond. It was further alleged R1 does not receive incontinent care throughout the night and facility staff are unable to transfer R1 when using the hoyer lift. R1 was interviewed and corroborated the allegations.

Regarding the allegation "Night staff do not respond to resident's call for assistance", LPA reviewed the facility’s program description noting each resident will receive routine observation, care, and supervision. LPA reviewed R1’s Physician’s Report (LIC 602A) dated 3/21/23 indicating R1 is able to communicate their needs and does not exhibit confusion or wandering behavior. LPA also reviewed R1’s Appraisal/Needs and Services Plan (LIC625) dated 2/15/2023 noting R1 exhibits confusion. Licensee was interviewed and reported overnight staff have a baby monitor near them to listen and respond to resident bell calls, incidents, and emergencies.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
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 2
Control Number 18-AS-20230901085939
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: AVOCADO CREEK
FACILITY NUMBER: 374602565
VISIT DATE: 12/16/2024
NARRATIVE
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Two (2) care staff were interviewed and reported they check on the residents three (3) times during night hours and are able to hear resident bell calls from the baby monitor. Both staff interviewed reported they have not received complaints from residents reporting they sounded the bell during night hours and did not receive assistance. Two (2) additional residents were interviewed of which one (1) reported they are independent and do not require assistance from facility staff. One (1) of two (2) residents interviewed reported they do not require assistance from staff during night hours and only sound the bell to call for help during the day, to which facility staff respond in a timely manner.

Regarding the allegation "Staff left resident in soiled diapers for an extended time period" R1's LIC 602A indicates R1 does not have the capacity to care for their own toileting needs. Staff 1 was interviewed and reported R1 exhibited memory lapses as evidenced by their complaints of staff not providing incontinent care moments after S1 changed their brief. An additional staff was interviewed and reported they assist R1 with incontinent care as necessary. Two (2) residents were interviewed, of which one (1) reported they do not require assistance with incontinent care. One (1) of two (2) residents interviewed reported facility staff provide incontinent care to them in a timely manner.

Regarding the allegation "Staff on duty is unable to transfer resident" R1's LIC 602A indicates R1 is non-ambulatory and does not have the capacity to independently transfer themselves to and from bed. Licensee reported all facility staff received hoyer lift training to assist R1 with transfers. LPA reviewed the facility’s Training Log signed by facility staff documenting on 9/6/2023 they received a one (1) hour hoyer lift operation training for R1. Two (2) staff were interviewed and confirmed they received hoyer lift training and added they assist R1 with transfers anytime they request it. Two (2) residents were interviewed, of which one (1) reported they are able to independently transfer themselves to and from bed. One (1) of two (2) residents interviewed reported staff assist them with transfers each time they request it.

Information gathered by the two (2) additional residents interviewed did not corroborate or refute the allegations. LPA made several attempts to contact R1's responsible person for an interview but was unsuccessful. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegation is unsubstantiated. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee.

SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2