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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603444
Report Date: 10/30/2020
Date Signed: 10/30/2020 03:25:08 PM



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
10/21/2019 and conducted by Evaluator Lizzette Tellez
COMPLAINT CONTROL NUMBER: 08-AS-20191021122259
FACILITY NAME:OPALEC BOARD AND CAREFACILITY NUMBER:
374603444
ADMINISTRATOR:EUGENIO OPALECFACILITY TYPE:
740
ADDRESS:5638 PLUMAS STREETTELEPHONE:
(619) 434-6366
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:6CENSUS: 5DATE:
10/30/2020
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator Leanne OpalecTIME COMPLETED:
02:55 PM
ALLEGATION(S):
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Staff failed to provide authorized representative with a copy of the Admission Agreement in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lizzette Tellez contacted the facility via telephone to deliver findings for a complaint investigation due to COVID-19. LPA identified herself and discussed the purpose of the call with Administrator Leanne Opalec.

Investigation consisted of interviews with staff and outside sources, and review of records. It was alleged that facility staff failed to provide Resident #1’s (R1) authorized representative with a copy of the Admission Agreement in a timely manner. Ms. Opalec was provided with Confidential Names Form in order to identify R1. Investigative interviews and record review revealed that on September 13, 2019, R1 was admitted into the facility. On September 14, 2019, R1’s authorized representative and facility representative entered into and signed an admission agreement. Interviews with staff and review of electronic records revealed that on September 22, 2019, approximately eight (8) days after the admission agreement was signed, staff attempted to send an electronic copy to R1’s authorized representative via email but the process was unsuccessful. Staff were unaware that the email had remained in the outbox
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 219-9755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
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 5
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
10/21/2019 and conducted by Evaluator Lizzette Tellez
COMPLAINT CONTROL NUMBER: 08-AS-20191021122259

FACILITY NAME:OPALEC BOARD AND CAREFACILITY NUMBER:
374603444
ADMINISTRATOR:EUGENIO OPALECFACILITY TYPE:
740
ADDRESS:5638 PLUMAS STREETTELEPHONE:
(619) 434-6366
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:6CENSUS: DATE:
10/30/2020
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator Leanne OpalecTIME COMPLETED:
02:55 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff failed to notify authorized representative.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lizzette Tellez contacted the facility via telephone to deliver findings for a complaint investigation due to COVID-19. LPA identified herself and discussed the purpose of the call with Administrator Leanne Opalec.

Investigation consisted of interviews with staff and outside sources, and review of records. It was alleged that facility staff failed to notify Resident #1's (R1) authorized representative of R1's death. Ms. Opalec was provided with Confidential Names Form, in order to identify R1. Investigation revealed that on the evening of October 10, 2019, Investigation consisted of interviews with staff and outside sources, and review of records. Investigation revealed that at approximately 1900 hours on October 10, 2019, R1 passed away while residing at the facility. Facility staff notified the outside health agency (OHA) overseeing R1’s medical needs. Investigative interviews revealed that the OHA and facility staff made multiple attempts to notify R1’s authorized representative of R1’s death between the hours of 19:10 and 20:00 on October 10, 2019, but were unsuccessful. Record review and investigative interviews revealed
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 219-9755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20191021122259
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: OPALEC BOARD AND CARE
FACILITY NUMBER: 374603444
VISIT DATE: 10/30/2020
NARRATIVE
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that the phone number on file for R1’s authorized representative was accurate. On the morning of October 11, 2019, R1’s authorized representative was notified of R1’s death during a routine call. Therefore, there were less than 24 hours between the time of R1’s death and the authorized representative learning of R1’s death. This Department has investigated the allegation that facility staff failed to notify R1’s authorized representative of R1’s death and has found that, based upon interviews and record review, there is insufficient evidence to prove or corroborate the allegation. Therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted with Ms. Opalec via telephone and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to her via email. An electronic email read receipt confirms the documents were received.
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 219-9755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20191021122259
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: OPALEC BOARD AND CARE
FACILITY NUMBER: 374603444
VISIT DATE: 10/30/2020
NARRATIVE
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and the authorized representative had not received a copy. This Department has investigated the allegation that facility staff failed to provide R1’s authorized representative with a copy of the Admission Agreement in a timely manner and has found that, based upon interviews and record review, the preponderance of the evidence standard has been met. Therefore, this allegation has been deemed Substantiated.

This deficiency is noted on the attached 9099-D and is cited in accordance with the California Code of Regulations, Title 22. An exit interview was conducted with Ms. Opalec via telephone and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to her via email. An electronic email read receipt confirms the documents were received.
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 219-9755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20191021122259
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: OPALEC BOARD AND CARE
FACILITY NUMBER: 374603444
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/02/2020
Section Cited
CCR
87507(e)
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ADMISSION AGREEMENTS
The licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative, if any, immediately upon signing the admission agreement or modification...
This requirement was not met as evidenced by:
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Administrator stated a copy of the signed admission agreement will be provided to R1's authorized representative by 11/02/20. Proof to be provided to CCL by POC date.
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Based on record review and interview, the licensee did not provide a copy of the signed admission agreement to R1's authorized representative. This posed a potential personal rights risk to R1.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 219-9755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
LIC9099 (FAS) - (06/04)
Page: 5 of 5