374603439-9-13-2023-08-AS-LTEZ-CW5SPT-20230929140341

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603439
Report Date: 09/13/2023
Date Signed: 09/13/2023 01:03:31 PM

Unfounded

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
05/19/2023 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20230519130944

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: 205	DATE:	09/13/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Executive Director Kurt Norden		TIME COMPLETED:	01:05 PM

ALLEGATION(S):

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Licensee did not meet residents mobility needs
Licensee did not ensure residents have access to activities

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to conduct follow up and deliver findings regarding the above mentioned allegations. LPA was greeted by, identified herself to, and explained the purpose of the visit and the basic elements of the complaint with Executive Director Kurt Norden.

During today’s visit, LPA observed residents in care and interviewed residents and staff.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that the Licensee did not meet residents’ mobility needs and the Licensee did not ensure residents have access to activities. Interviews and review of medical records revealed that Resident 1 (R1) did not have any cognitive impairment, used a walker and wheelchair, and required assistance with ambulation and escorting to activities.
Continued on LIC9099-C page...

Unfounded

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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-20230519130944

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: 09/13/2023

NARRATIVE

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Interviews with outside sources revealed that in April 2023, R1 and their responsible party scheduled an appointment with an outside electric wheelchair company for assessment and training for R1 to use an electric wheelchair to be conducted in May 2023. Interviews with outside sources and records review revealed that an outside vendor did not receive the paperwork required for R1’s assessment and training to use an electrical wheelchair, which resulted in the appointment being cancelled. Interviews with outside sources revealed that the outside vendor rented space within the facility building and did not have any connection with the facility. Interviews with residents and staff did not reveal any concerns regarding the facility’s involvement in R1’s assessment and training for the use of the electric wheelchair. Interviews with staff revealed that the facility was in communication with R1’s responsible party regarding facility policy regarding electric wheelchair use and covered the cost of the training hours for R1.

The tour of the facility revealed that the facility has several stand-alone buildings which are separated by a street with a crosswalk. Interviews with staff and residents revealed that activities are hosted in both the independent building and the assisted living building, where R1 resided. Assisted living residents were either escorted across the street by staff or had been assessed to be capable of walking across the street independently. Interviews with staff revealed that the facility attempted to offer activities in both buildings whenever possible to allow all residents to attend a specific activity. Interviews with staff revealed that escorting services are provided free of charge when activity staff are available and able to meet the needs of the residents that are requesting escorting. Interviews with staff, residents, and outside sources revealed that residents were able to request an escort and the facility only charged for escorting when it became a regular occurrence. Interviews confirmed that prior to the approved use of the electric wheelchair, R1 was receiving escorting services to activities in the independent building. During LPA’s visit on 9/13/2023, LPA observed residents in the assisted living building attending activities. Interviews with residents and staff did not reveal any difficulties or issues with requesting escorting services.

The Department has investigated the above-mentioned allegations and based on interviews, LPA observations, and records review, it was determined that the complaint allegations are Unfounded, meaning that the allegations are false, could not have happened and/or are without a reasonable basis.

An exit interview was conducted with Executive Director Kurt Norden and Resident Services Director Coco Feng, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC9099 (FAS) - (06/04)

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