374602653-11-15-2021-08-AS-SJAB-C9YPVH-20211223103908

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602653
Report Date: 11/12/2021
Date Signed: 11/15/2021 08:09:14 AM

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
10/07/2021 and conducted by Evaluator Kristina Ryan

COMPLAINT CONTROL NUMBER: 08-AS-20211007162431

FACILITY NAME:	AEGIS ASSISTED LIVING AT SHADOWRIDGE		FACILITY NUMBER:	374602653
ADMINISTRATOR:	LANCE SHENK		FACILITY TYPE:	740
ADDRESS:	1440 SOUTH MELROSE DRIVE		TELEPHONE:	(760) 806-3600
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	95	CENSUS: 59	DATE:	11/12/2021
		UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Wellness Director, Caroline Kilby		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

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Staff is not allowing family member to visit resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kristina Ryan, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA was allowed entry into the facility after identifying herself and stating the purpose of the visit. LPA met with Wellness Director, Caroline Kilby.

The Department’s investigation consisted of a review of facility records. It also involved interviews with facility staff, and outside sources.

The Department received a complaint on October 7, 2021 alleging that the facility was not allowing a family member to visit a resident. Interviews with facility staff and with outside sources confirmed that the facility had temporarily suspended all non- essential indoor visits due to positive COVID-19 cases in the community.

(CONTINUED ON LIC 9099-C, 1 of 2)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina Ryan	TELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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 08-AS-20211007162431

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: AEGIS ASSISTED LIVING AT SHADOWRIDGE	FACILITY NUMBER: 374602653
	VISIT DATE: 11/12/2021

NARRATIVE

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On September 23, 2021, an email was sent by a facility representative to residents and their responsible parties stating that the facility was required by the County of San Diego to implement quarantine measures due to a staff person testing positive for COVID-19. As additional positive cases were confirmed, the facility sent updated emails and communications delaying family visitation indoors. Interviews with outside agencies and facility staff revealed that the facility had misconstrued the guidance provided to them by the County of San Diego Public Health. The facility was taking suggestions and recommendations from county employees and applying them as requirements. Although the facility had a requirement to report positive COVID-19 cases to Community Care Licensing, this requirement was not met, and the facility only reported to San Diego County Public Health. This lack of required reporting delayed a response from Community Care Licensing to provide clarification regarding the appropriate visitation requirements. A review of the visitation practices per Community Care Licensing Provider Information Notices confirmed that there is no requirement for indoor visitation of residents to be halted due to positive COVID-19 cases in a facility. Due to the facility’s misunderstanding of the requirements, indoor visitation was not allowed by resident’s family from the time period of September 23, 2021 to October 8, 2021.

Based on interviews, and reviewed records, a preponderance of evidence exists to substantiate the allegation. A deficiency is cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with Wellness Director, Caroline Kilby. An exit interview was conducted with Caroline Kilby, a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided to the administrator via e-mail.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina Ryan	TELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20211007162431

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: AEGIS ASSISTED LIVING AT SHADOWRIDGE	FACILITY NUMBER: 374602653
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/12/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/12/2021 Section Cited CCR 87468.1(11)	1 2 3 4 5 6 7	84468.1 (11) Personal Rights of Residents in All Facilities To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon.This requirement was not met by;	1 2 3 4 5 6 7	Wellness Director agreed to train Facility Staff on PIN 21-40-ASC. Training will occur on or before November 24, 2021. Facility will provide training topics to LPA and sign in sheet by November 29, 2021
	8 9 10 11 12 13 14	Based on interviews and records review the licensee did not permit residents to visit privately during reasonable hours for 61 of 61 persons in care which posed a potential Personal Rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina Ryan	TELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC9099 (FAS) - (06/04)

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