374603136-10-18-2022-08-AS-DPOL-CKQSQL-20221031140455

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603136
Report Date: 10/18/2022
Date Signed: 10/18/2022 05:16:12 PM

Substantiated

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
05/26/2022 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20220526144233

FACILITY NAME:	CORONADO RETIREMENT VILLAGE		FACILITY NUMBER:	374603136
ADMINISTRATOR:	ELIZABETH REYES		FACILITY TYPE:	740
ADDRESS:	299 PROSPECT PLACE		TELEPHONE:	(619) 437-1777
CITY:	CORONADO	STATE: CA	ZIP CODE:	92118
CAPACITY:	120	CENSUS: 74	DATE:	10/18/2022
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Administrator, Liz Reyes		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Facility did not ensure infection control practices were maintained

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Administrator, Liz Reyes.

The Department investigated the above listed complaint allegation. The investigation consisted of a tour of the facility, interviews with staff and review of facility records including LIC808 Mitigation Plan Report, Community Care Licensing, (CCL) Infection Control Inspections Reports, and Covid-19 positive case line list and other relevant records.

On May 26, 2022, it was alleged that facility staff did not ensure infection control practices were maintained. The details of the allegation stated that Covid-19 positive residents were sharing rooms with Covid-19 residents. During the time this complaint was filed, the facility was managing a Covid-19 outbreak in the memory care unit.

Continue at LIC9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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-20220526144233

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: CORONADO RETIREMENT VILLAGE	FACILITY NUMBER: 374603136
	VISIT DATE: 10/18/2022

NARRATIVE

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Continue from LIC9099

Initial covid positive case was reported to CCL on May 26, 2022. Sixteen memory care residents and three staff members tested positive on May 25, 2022, during routine weekly testing surveillance. During the outbreak, the facility received guidance from the COVID-19 Site Assessment Nurse, with the Department of Public Health Infectious Disease Control. In addition, as it was standard protocol to mitigate the spread of Covid-19 during an outbreak, CCL staff conducted daily monitoring with the facility’s Infection Control Lead to provide infection control guidelines and technical assistance.

On June 1, 2022, the Department conducted a visit at the facility to commence the complaint investigation which included a tour of the facility. During the tour, it was observed the facility had one central entry point for universal entry screening and routine symptom screening was initiated at entry for all staff and visitors. It was observed that signs were posted at facility entrance and signs throughout the facility to promote face covering, hand hygiene, cough/sneeze etiquette and physical distancing. All isolation rooms were properly identified with signage and Personal Protective Equipment (PPE) supplies were stored outside the isolation rooms. Staff were observed wearing N-95 respirators and in full PPE gear when entering the isolation rooms. No violations were observed during the tour.

Review and reconciliation of Covid-19 positive line list, resident roster and room accommodations indicated that Covid-19 positive residents were in isolation by themselves in their own rooms. In cases when the residents were sharing rooms, they were sharing with another Covid-19 positive resident. However, records review and staff interviews disclosed one resident that tested positive for Covid-19 on May 25, 2022 shared a room with a resident that tested negative for Covid-19 on the same day. Both residents were asymptomatic and fully vaccinated. The residents remained in the same room for three days, which resulted in the non Covid-19 resident being exposed to Covid-19 during the infectious period. Review of facility room availability indicated there were four (4) empty rooms available for isolation on May 25, 2022. When staff realized the oversight, the Covid-19 positive resident was immediately moved to an empty room on May 28, 2022, and subsequently cleared from quarantine on June 3, 2022. The non-Covid-19 resident did not test positive for Covid-19. During interviews, staff indicated they were busy managing the Covid-19 outbreak and failed to isolate the Covid-19 positive resident to protect the non-Covid-19 resident. Review of the facility Covid-19 infection control plan for shared rooms outlined the following protocols: (1) Do not transfer a resident with negative result in a room with Covid-19 positive resident, and (2) Upon finding positive results immediately try to separate shared room residents unless both are positive or both display symptoms. Continue on LIC9099C

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20220526144233

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: CORONADO RETIREMENT VILLAGE	FACILITY NUMBER: 374603136
	VISIT DATE: 10/18/2022

NARRATIVE

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Continue from LIC9099C

The Department has investigated the above-mentioned allegation and has found that there was sufficient evidence to corroborate the allegation. Therefore, this allegation is deemed to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. A deficiency was cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on LIC 9099-D. A plan of corrections was developed with Administrator, Liz Reyes.

An exit interview was conducted with Administrator, Liz Reyes, to whom a copy of this report, Deficiency Report LIC9099D, and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20220526144233

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: CORONADO RETIREMENT VILLAGE	FACILITY NUMBER: 374603136
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/18/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/18/2022 Section Cited CCR 87470(b)(3)	1 2 3 4 5 6 7	Infection Control Requirements …. when one or more residents in the facility are diagnosed with a communicable disease, the following shall apply: There shall be separation and care of residents whose illness requires separation, including quarantine or isolation, from others. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The following plan of correction was instituted; (1) Facility management implemented additional procedures to ensure isolation procedures were followed by staff, (2) Additional Covid-19 infection control training was provided to all staff. Plan of correction was completed on June 10, 2022.
	8 9 10 11 12 13 14	Based on observation, interviews, and review of Covid-19 related records, staff did not separate 1 of 16 residents in care from residents infected with the Covid-19 virus during the required quarantine period. This posed a potential health risk to a resident 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: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC9099 (FAS) - (06/04)

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