374603439-3-26-2024-08-AS-JLOT-D3SVBF-20240328161727

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603439
Report Date: 03/26/2024
Date Signed: 03/26/2024 03:23:42 PM

Unfounded

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
12/15/2020 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20201215143254

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:	03/26/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Executive Director (ED) Kurt Norden		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility does not provide reasonable accommodation for resident to receive phone calls.
Facility failed to provide food of good quality.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to conclude a complaint investigation regarding the above-mentioned allegations. LPA Correia was greeted by Marketing Receptionist Wilson, identified herself and met with Executive Director (ED) Kurt Norden and explained the purpose of the visit.

The Department’s investigation consisted of facility, outside source, and resident records reviews. The investigation also included outside source and staff and interviews.

It was alleged the facility did not provide reasonable accommodations for Resident (R1) to receive phone calls. A resident records reviews revealed R1 was admitted to the facility on September 30, 2011, with a primary diagnosis of Hypertension and Congestive Heart Failure (CHF). R1 resided in a private room located in the independent unit of the facility. An interview conducted with the ED revealed resident rooms all have a personal land line with their own phone number.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

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-20201215143254

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: 03/26/2024

NARRATIVE

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It was also revealed that staff had no control over phone calls made or received by residents in care. An interview conducted with an outside source 1 (OS1) revealed R1 would screen their calls due to receiving calls from an individual that would cause them to become distressed.

It was also alleged the facility failed to provide food of good quality. Records reviews of facility, resident, and an outside source agency revealed R1 had experienced a decline in health and on March 13, 2020, R1 was placed on Hospice. An interview with the ED and Staff 1 (S1) revealed at the time of the complaint due to the COVID-19 pandemic facilities had ceased communal dining and facility staff began delivering residents three meals a day with an option of two choices. A facility records review revealed the meals offered were of nutritional value. Additionally, a resident record review dated, December 3, 2020, disclosed R1 experienced a change in condition and hospice was also treating R1 for anorexia due to a lack of appetite. The records also disclosed R1 did not require a special diet, however due to their lack of appetite R1’s meals were to be reviewed by a caregiver. R1’s Responsible Party (RP) requested no changes to be made to R1’s care plan. [See LIC 811 for Confidential Names]

Based on records reviews and interviews, the above-mentioned allegations were determined to be unfounded, meaning that the allegations were false, could not have happened and/or were without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with ED Norden who was informed they will be provided a copy of this report and Licensee Rights (LIC 9058), whose signature below confirms receipt of these documents.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

LIC9099 (FAS) - (06/04)

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