374603136-9-26-2023-08-AS-SJAB-CW4MMB-20230928094339

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603136
Report Date: 09/26/2023
Date Signed: 09/26/2023 06:10:54 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
06/29/2023 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20230629135237

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: 80	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	08:06 AM
MET WITH:	Lisa Ballard Human Resources Manager		TIME COMPLETED:	10:07 AM

ALLEGATION(S):

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Resident was denied visitors
Resident was not accorded privacy
Medication not given as prescribed
Untrained staff provided catheter care
Facility staff did not obtain medical attention for resident
Facility staff did not notify POA of changes in resident's condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings in the above complaint allegations. LPA Domingo identified herself and discussed the purpose of the visit with Administrator Elizabeth Najera.

On June 29, 2023 Community Care Licensing (CCL) received a complaint alleging
resident was denied visitors, resident was not accorded privacy, medication not given as prescribed, untrained staff provided catheter care, Facility staff did not obtain medical attention for resident and Facility staff did not notify POA of changes in resident's condition.

[Continued on LIC9099C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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-20230629135237

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: CORONADO RETIREMENT VILLAGE	FACILITY NUMBER: 374603136
	VISIT DATE: 09/26/2023

NARRATIVE

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[Continued from LIC9099]

During investigation, LPA Domingo collected pertinent resident records as well as facility documentation. Based on Resident1’s (R1) (See LIC811 list of confidential list of identification)Physician Report dated January 11, 2023 revealed that Resident 1 (R1) does not have cognitive deficits. R1 is able to verbalize any needs or concerns. R1 is able to state who is to visit and not to visit.

Allegations received stated that R1 was not accorded privacy . According to Outside Source 1 (OS1), R1 verbalized wanting facility staff to be present during visits. Outside source 2 (OS2) also concurred and verified that R1 has requested a staff member to be present during visitations. Outside Source 3 (OS3) wrote a statement that also verified that R1 verbally stated that visitations are to be supervised.

Allegation stated that R1’s medication was not given as prescribed. Records reviewed showed no evidence of medication not given as prescribed. O3 was interviewed and stated that R1's medication was properly given. O2 was interviewed and R1's medication was given as prescribed. Staff 1 (S1) reviewed records of R1's medication and there was no evidence of medication not given as prescribed.

Allegation stated that untrained staff provided catheter care for R1. Interview with Staff 2 (S2) revealed that R1's catheter was being cared for by a trained staff member. Records reviewed revealed that R1 was taken to the hospital as needed when there was a medical need regarding R1's catheter care. Outside Source 4 (OS4) was interviewed and corroborated with R1's record review.

Allegation stated that facility staff did not obtain medical attention for resident. OS4 was interviewed and there were no instances of staff not obtaining medical attention for R1. S1 was interviewed and R1's medical needs were being met. Records reviewed documented R1's medical needs were being met by the facility staff.

[Continue on LIC9099]

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20230629135237

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: CORONADO RETIREMENT VILLAGE	FACILITY NUMBER: 374603136
	VISIT DATE: 09/26/2023

NARRATIVE

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[Continued from LIC9099]

Lastly, it was alleged that facility staff did not notify responsible party of changes in resident condition. Records reviewed documented communication with responsible party of all changes related to R1. OS1 was interviewed and verified that any changes were communicated. LPA Domingo reviewed records that collaborated any changes with R1 was communicated.

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: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

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