374603029-2-7-2024-08-AS-IESA-D2X5L8-20240229190243

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603029
Report Date: 02/07/2024
Date Signed: 02/07/2024 03:16:30 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
08/27/2021 and conducted by Evaluator Becky Kennedy

COMPLAINT CONTROL NUMBER: 08-AS-20210827154651

FACILITY NAME:	EASY LIVING @ TORREY DEL MAR		FACILITY NUMBER:	374603029
ADMINISTRATOR:	CALCETAS, MYRNA		FACILITY TYPE:	740
ADDRESS:	13858 KERRY LANE		TELEPHONE:	(858) 538-8588
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92130
CAPACITY:	6	CENSUS: 5	DATE:	02/07/2024
		UNANNOUNCED	TIME BEGAN:	02:43 PM
MET WITH:	Myrna Calcetas		TIME COMPLETED:	03:59 PM

ALLEGATION(S):

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Resident sustained injuries while in care due to neglect or lack of supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst Becky Kennedy concluded the investigation which began on 08/31/2021. LPA Kennedy made an unannounced visit to the above facility today and met with Myrna Calcetas, Administrator. LPA advised her of the reason for today's visit and delivered the investigation findings on the above allegation.

The investigation into the above allegations consisted of interviews with internal and external sources, a review of internal and external documents, and a tour of the facility.

It was alleged that a resident sustained injuries while in care due to neglect or lack of supervision.

The investigation revealed that Resident 1 (R1) fell in their room likely while attempting to get out of bed. R1 sustained injuries as a result of the fall. Facility staff responded swiftly to assess R1 and took appropriate action to provided needed medical care.

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: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

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-20210827154651

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: EASY LIVING @ TORREY DEL MAR	FACILITY NUMBER: 374603029
	VISIT DATE: 02/07/2024

NARRATIVE

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Interviews with both internal and external sources and a review of internal and external documents provided no evidence of neglect, or a lack of care provided to R1.

Based on the evidence obtained during the complaint investigation, the allegation above is UNSUBSTANTIATED, meaning there isn’t sufficient evidence to prove the violation occurred.

An exit interview was conducted with Myrna Calcetas, a copy of this report and Licensee's Rights (LIC9058) were left at the facility.

SUPERVISOR'S NAME: Icela Estrada	TELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky Kennedy	TELEPHONE: 619-672-5843
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

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