374602580-1-12-2024-08-AS-LTEZ-CZQQSX-20240122112612

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602580
Report Date: 01/12/2024
Date Signed: 01/12/2024 12:29:21 PM

Unsubstantiated

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
09/03/2021 and conducted by Evaluator Becky Kennedy

COMPLAINT CONTROL NUMBER: 08-AS-20210903091901

FACILITY NAME:	BOSWORTH GARDENS RCFE II		FACILITY NUMBER:	374602580
ADMINISTRATOR:	JONES, DYNA ROSE		FACILITY TYPE:	740
ADDRESS:	793 WICHITA AVENUE		TELEPHONE:	(619) 938-2900
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY:	0	CENSUS: 0	DATE:	01/12/2024
		UNANNOUNCED	TIME BEGAN:	12:06 PM
MET WITH:	Unavailable		TIME COMPLETED:	12:37 PM

ALLEGATION(S):

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Staff did not quarantine after testing positive for COVID-19
Staff that tested positive for COVID-19 does not use PPE

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Becky Kennedy concluded the investigations into the above allegations. The investigation began on 9/9/2021.

It was alleged that staff did not quarantine after testing positive for COVID-19 and that staff that tested positive for COVID-19 does not use Personal Protective Equipment (PPE).
The Department’s investigation consisted of review of facility records, interviews with internal and outside sources, and observations.

The investigation revealed that on 8-25-2021 Staff Member 1 (S1) tested positive for COVID during the facility’s regular weekly COVID testing. S1 had been vaccinated and their symptoms were mild. S1 quarantined for three or four days following the positive test results. Facility staff became unavailable to provide care and S1 began caring for residents. S1 provided care for residents in full PPE including an N95 respirator to protect residents from infection.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Icela Estrada	TELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky Kennedy	TELEPHONE: 619-672-5843
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

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-20210903091901

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: BOSWORTH GARDENS RCFE II	FACILITY NUMBER: 374602580
	VISIT DATE: 01/12/2024

NARRATIVE

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LPA observed facility staff wearing face coverings (masks) appropriate for the COVID infection status of the facility.

S1 providing care for residents following a positive COVID test in full PPE did not violate the residents’ personal right to healthful accommodations.

Based on the evidence obtained during the complaint investigation, the above allegations are UNSUBSTANTIATED, meaning there is not a preponderance of the evidence to prove that the alleged violations occurred.

This report, along with Licensee Rights were mailed to the licensee via USPS mail to the last known address on file.

SUPERVISOR'S NAME: Icela Estrada	TELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky Kennedy	TELEPHONE: 619-672-5843
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

LIC9099 (FAS) - (06/04)

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