374603439-7-2-2024-08-AS-SJAB-DC2RGC-20241217120031

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603439
Report Date: 07/02/2024
Date Signed: 07/02/2024 02:15:49 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
09/20/2022 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20220920143303

FACILITY NAME:	CASA DE MANANA		FACILITY NUMBER:	374603439
ADMINISTRATOR:	JOHNSTON, ROBERT		FACILITY TYPE:	740
ADDRESS:	849 COAST BLVD		TELEPHONE:	(858) 454-2151
CITY:	LA JOLLA	STATE: CA	ZIP CODE:	92037
CAPACITY:	249	CENSUS: 209	DATE:	07/02/2024
		UNANNOUNCED	TIME BEGAN:	09:24 AM
MET WITH:	Catherine Sullivan, Executive Assistant & Rita Moreno, Director of Health Services		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff mishandled the residents medications
Staff do not take universal precautions while providing care
Staff do not properly maintain the facility
Staff did not prevent a resident from wandering
Resident sustained an unexplained injury while in care
Staff did not ensure a resident consumed an appropriate amount of fluids while in care
Staff did not meet a resident's incontinence needs while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tiffany Holmes conducted a complaint investigation visit to deliver findings for the above-mentioned allegations. LPA met with Catherine Sullivan, Executive Assistant & Rita Moreno, Director of Health Services and shared the findings.

The Department’s investigation consisted of interviews and records review. It was alleged staff mishandled the residents medications . Interviews revealed that the staff carry a secured case that holds the residents medications. They deliver the medications to each resident from a pre poured cup. The staff wear gloves and sanitize/wash their hands when working with the medications and while dispersing them. Interviews revealed the staff give the residents the medications and make sure the residents have something to drink along with taking the medications.

It was also alleged that staff do not take universal precautions while providing care. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

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-20220920143303

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: CASA DE MANANA	FACILITY NUMBER: 374603439
	VISIT DATE: 07/02/2024

NARRATIVE

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Interviews revealed the facility staff use universal precautions while working at the facility. The residents clean and sanitize the counter areas and flooring and tables along with anything else that needs to be sanitized. The staff wear gloves to be safe and masks as well. The gloves are worn while dispensing medications, changing residents, and assisting residents with incontinence.
It was alleged that staff do not properly maintain the facility. Interviews revealed the staff clean and maintain the facility. The facility uses bleach or antibacterial wipes for disinfecting surfaces and cleaning in the resident rooms. Interviews did not report any odors in the facility.

It was alleged that staff did not prevent a resident from wandering. Interviews revealed most residents are able to leave the facility unassisted. The residents that are not allowed to leave on their own are supervised and live in the assisted portion of the facility. The staff redirect the resident they know that usually wander. When a resident does wander off from the facility the staff will look for the resident and bring them back and file a report of them AWOLing. At the time the complaint came in there were no AWOLs reported nor did any happen.

It was alleged that the resident sustained an unexplained injury while in care. Interviews revealed around the time the complaint in, there were no incidents reported to the facility staff regarding any residents having or sustaining any injuries while in care. When there is an incident that takes place the staff immediately notify the family, then they put it in writing, how the incident took place and then after the staff report it, they complete the electronic report and a fax to the doctor, then the report will go to the director of health services and then they review and make sure all the charting and details are there and that the staff have notified all responsible parties. Director of residents services will put out any reports if it verified that the resident has had an injury. They document when the resident come back to the facility and the nurses will chart again how they are feeling and anything that is observed.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20220920143303

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: CASA DE MANANA	FACILITY NUMBER: 374603439
	VISIT DATE: 07/02/2024

NARRATIVE

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It was alleged that staff did not ensure a resident consumed an appropriate amount of fluids while in care. Interviews revealed the facility staff continuously offer resident fluids to keep them hydrated. The residents that have been diagnosed with major neuro cognitive disorder need constant reminders to drink. The facility has water stations around and the residents can grab water on their own and for the others they are offered the water throughout the day. Interviews revealed each caregiver at the beginning of their shifts they check 6 items to make sure the residents are okay, they make sure they have water, have their pendant on, their remote, have their tray table close to them and if they need to be repositioned and toileting.

It was alleged that staff did not meet a resident's incontinence needs while in care. Interviews revealed the residents that are incontinent are assisted with their toiletry needs. The residents are changed timely and once they request needing a change they are changed as soon they are notified which is included in each round.

Due to lack of corroborating evidence, the findings regarding the above allegations were established to be unsubstantiated. This finding means although the allegations may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

LPA Holmes conducted an exit interview with Catherine Sullivan, Executive Assistant & Rita Moreno, Director of Health Services and they were provided with a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 03/22) and their signature on this report acknowledges receipt of the rights.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

LIC9099 (FAS) - (06/04)

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