374603136-3-29-2023-08-AS-JRAE-CQF2LX-20230330173015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603136
Report Date: 03/22/2023
Date Signed: 03/29/2023 10:26:15 AM

Unsubstantiated

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
03/24/2022 and conducted by Evaluator Iby Strong

COMPLAINT CONTROL NUMBER: 08-AS-20220324080455

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: 85	DATE:	03/22/2023
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Administrator Elizabeth Najera		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff prevent resident from going out of the facility
Staff did not safeguard resident’s personal belongings
Staff speak inappropriately to resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to interview residents, and staff and to deliver findings in the above complaint allegations. LPA identified herself and discussed the purpose of the visit with Administrator Elizabeth Najera.

On March 24, 2022, Community Care Licensing (CCL) received a complaint alleging staff prevented resident from going out of the facility, staff did not safeguard resident’s personal belongings, and staff spoke inappropriately to resident in care.

During investigation, LPA Strong collected pertinent resident records as well as facility documentation. Based on Resident1’s (R1) Physician Report dated September 20, 2021, R1 is diagnosed with a Major Neurocognitive Disorder, is confused and disoriented, depressed and cannot leave facility unassisted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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-20220324080455

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: 03/22/2023

NARRATIVE

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An updated Physicians Report dated March 14, 2023, revealed that R1 has behavioral disturbances with psychosis and has wandering behavior. Additionally, R1’s Needs and Services Plan dated April 22, 2022, R1 refuses any type of medical care and is often confused.

Allegations received stated that R1 was not allowed to leave facility. According to outside source interview, R1 is often confused and is unable to leave facility unassisted due to diagnosis. Additionally, outside source interview revealed that outside source and Administrator have been working to find R1 a higher level of care. Interview with Administrator revealed that R1 will wander and is often disoriented. Records collected corroborated that R1 has a history of wandering away from the facility alone and cannot leave facility unassisted.

Allegation also states that R1’s personal belongings have been taken by Administrator or stolen by an unknown source including pets, cellular phones, and wheelchair. Interview with Administrator revealed that R1 arrived at the facility after a day out with a friend with two dogs. Administrator stated that R1 did not have any pets and later found that an unknown person was attempting to request $500 directly from R1 for the two dogs. Administrator stated dogs were later taken by R1's friend.

Interview with outside source revealed that R1 often states that her personal items have been stolen but are later found within R1’s room. Outside source also revealed that R1 often accuses staff of stealing her items but outside source would remind R1 that either she lost the item, or it was donated prior to her move to facility. Outside source confirmed that multiple items including a wheelchair and massage table were donated prior to R1’s move in date. Outside source also confirmed that R1 has lost five cellular phones during her stay at the facility.

Lastly, it was alleged that staff insulted R1’s memory loss. Interview with outside source revealed R1 has a history of making false statements against anyone who does not agree with R1. Interview with Administrator revealed that R1 has accused Administrator of insulting R1 though Administrator revealed that R1 has never been insulted by Administrator or any other staff at facility.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 08-AS-20220324080455

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: 03/22/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based on LPA's interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Administrator Elizabeth Najera, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC9099 (FAS) - (06/04)

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