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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602608
Report Date: 04/05/2024
Date Signed: 05/29/2025 04:15:17 PM

Substantiated


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
04/02/2024 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240402144248
FACILITY NAME:SAILS ALEXANDERFACILITY NUMBER:
374602608
ADMINISTRATOR:LAUREN REPICIFACILITY TYPE:
735
ADDRESS:301 JOHAH RDTELEPHONE:
(760) 233-4036
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY:4CENSUS: 4DATE:
04/05/2024
UNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Maribel Robledo, AdministratorTIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Staff mismanaged resident’s medication.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made and unannounced visit to the facility commence a complaint investigation in regards to the allegation noted above. LPA was greeted and granted entry by Direct Support Professional (DSP) Yareli Rayo, and the Administrator Maribel Robledo arrived shortly after. LPA explained the purpose of the visit and the elements of the allegation.

On 4/2/24 Community Care Licensing received a complaint alleging that Resident #1 (R1) medication was mismanaged by staff. LPA conducted a review of all resident's files, facility's medication quality assurance (pre and post check) form and Medical Authorization Record (MAR). LPA observed for R1s medications to have been given as prescribed. However upon review of Resident #2 (R2) MAR two-12pm medications were not given on 2/11/24, as the facility was short staffed. Resident #3 (R3) 4pm medication was not given on 2/29/24, and there was no explanation provided on the back of the MAR as to why is was not administered. LPA conducted interviews with Facility Administrator Maribel which confirmed if there are no initials then the medication was not given. Additionally per staff interviews conducted revealed that R1 was observed to have
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
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 3
Control Number 18-AS-20240402144248
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: SAILS ALEXANDER
FACILITY NUMBER: 374602608
VISIT DATE: 04/05/2024
NARRATIVE
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missing initials on their MAR. Per the facility. Medication Quality Assurance check for March 2024 revealed for there to be initials missing for the staff preparing the medication, check prior to the medication being administered and post check of the medication being administered. Based on Interviews and records review the allegation of Staff Mismanaged resident's medication is Substantiated.


A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

A citation is being issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 6) on the attached 9099D.

An exit interview was conducted, and of this report, 9099D, LIC811 confidential names list, appeal rights, and LIC9098-proof of corrections form was provided to Maribel Robledo, Administrator.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20240402144248
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: SAILS ALEXANDER
FACILITY NUMBER: 374602608
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/19/2024
Section Cited
CCR
80075(5)(B)
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Health Related Services 5) If the client's physician has stated in writing that the client is unable to determine.....(B) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by:
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The licensee agrees to conduct an inservice on medication administration. Proof of POC is to be submitted to the department by 5pm on the due date indicated (4/19/24).
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The licensee did not ensure that R2 and R3s medications were given as prescribed. This poses a potential health, safety and personal rights risk to persons 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: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3