374603456-2-23-2023-08-AS-IESA-CPH8TX-20230228214841

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603456
Report Date: 02/23/2023
Date Signed: 02/23/2023 09:31:06 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/30/2021 and conducted by Evaluator Elizabeth Hamilton

COMPLAINT CONTROL NUMBER: 08-AS-20210730130649

FACILITY NAME:	ATRIA NORTH ESCONDIDO		FACILITY NUMBER:	374603456
ADMINISTRATOR:	MITCHELL, KATHLEEN		FACILITY TYPE:	740
ADDRESS:	1342 N ESCONDIDO BLVD		TELEPHONE:	(760) 480-8155
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92026
CAPACITY:	101	CENSUS: 63	DATE:	02/23/2023
		UNANNOUNCED	TIME BEGAN:	09:14 AM
MET WITH:	Sales Director, Carline Callaghan		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Neglect resulting in resident injury

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced complaint investigation visit at the facility. LPA was greeted at the front entrance by Sales Director, Carline Callaghan and granted entry after identifying herself. LPA explained the purpose of the visit which was to deliver findings for the above allegation.

The Department’s investigation consisted of record reviews including medical records, interviews with staff and outside sources.

On July 30, 2021, it was alleged that staff neglect resulted in resident injury. More specifically, it was alleged that on July 12, 2021, after resident 1 (R1) was transported to an appointment, they were escorted out of the vehicle without their walker and fell, resulting in nasal fracture and facial bruising.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

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-20210730130649

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: ATRIA NORTH ESCONDIDO	FACILITY NUMBER: 374603456
	VISIT DATE: 02/23/2023

NARRATIVE

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Interviews with staff and outside sources confirmed that on July 12, 2021, R1 had a medical appointment; however, R1 was out for a scenic drive with a group of residents. Facility staff and outside source verbally agreed that the facility driver would transport R1 to the medical appointment where outside source would be waiting. The outside source left the facility with R1’s walker since the facility did not transport resident walkers while on an outing for a scenic drive. The facility driver returned from the outing with the residents, including R1, in the facility van. The driver then transferred R1 to a smaller facility vehicle, by physically escorting them, holding R1’s arm, to transport them to the medical appointment. After the driver and R1 arrived in the parking lot of the medical building, the driver attempted to physically assist R1 by holding the resident’s arm. Interview statements confirmed that while R1 was being physically escorted their legs “buckled” resulting in a witnessed fall. Medical records reviewed confirmed R1 was assessed by paramedics and taken to the hospital where they were evaluated for minor trauma due to a witnessed fall and released the same day. The fall was determined as accidental in nature. Records reviewed confirmed R1 utilized a walker while ambulating; however, the assistive device was unavailable for use during the time in question, since it was in the possession of the outside source. There was insufficient evidence to support the allegation that staff neglect resulted in R1’s injury.

The Department has investigated the above allegation. Based on evidence obtained, including interviews and records reviewed, the allegation is determined as unsubstantiated as the Department could not meet the preponderance of the evidence standard.

An exit interview was conducted with Sales Director, Callaghan and a copy of this report and Licensee/Appeals Rights (LIC 9058 01/16) was provided.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

LIC9099 (FAS) - (06/04)

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