374603439-12-20-2022-08-AS-DPOL-CMKVS4-20221229154055

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603439
Report Date: 12/14/2022
Date Signed: 12/20/2022 02:19:02 PM

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
03/30/2022 and conducted by Evaluator Liliana Silveira

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20220330145921

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: 210	DATE:	12/14/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Executive Director Kurt Norden		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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-Licensee did not ensure medical care for resident.
-Licensee did not arrange transportation to medical appointment for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Liliana Silveira conducted a complaint investigation visit to deliver findings for the above-mentioned allegations. LPA Silveira met with Executive Director Kurt Norden and shared the findings.

The Department’s investigation consisted of interviews and records review. On 03/30/22, it was alleged that the Licensee did not ensure medical care for the resident. A records review, interview with the Director of Resident Services and interviews with outside sources revealed that the resident was independent and resided in the Independent Living (IL) sector of the facility. IL residents are not under the care and supervision of facility staff and coordinate their own hospital and doctor’s visits. The records review also revealed that during the time period in question, the resident did not request assistance for any medical or care issues at the facility and staff did not observe any reportable health or change in condition issues.

It was also alleged that the Licensee did not arrange transportation to a medical appointment for the resident. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

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-20220330145921

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: CASA DE MANANA	FACILITY NUMBER: 374603439
	VISIT DATE: 12/14/2022

NARRATIVE

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An interview with the Transportation Coordinator revealed that IL residents can request transportation services from the facility or request LYFT services since the facility has a contract with Lyft. The Transportation Coordinator also revealed that it is common for IL residents to coordinate their own transportation services without the facility being informed. Interviews with outside sources revealed that the resident requested UBER services to and from a medical appointment. An interview with the Resident Services Coordinator revealed that during the time period in question, the facility was not informed about this transportation request or that the resident was traveling to a medical appointment. Therefore, there was insufficient evidence to support this allegation.

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 Silveira conducted an exit interview with Kurt. At the time of the exit interview Kurt was provided with a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) and signature on this report acknowledges receipt of the rights.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

LIC9099 (FAS) - (06/04)

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