374603509-12-5-2023-08-AS-JLOT-CYYU9P-20231229142325

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603509
Report Date: 12/05/2023
Date Signed: 12/05/2023 05:29:31 PM

Unsubstantiated

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
09/20/2023 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230920152253

FACILITY NAME:	WESTMONT AT SAN MIGUEL RANCH		FACILITY NUMBER:	374603509
ADMINISTRATOR:	ROSSI, MARIA		FACILITY TYPE:	740
ADDRESS:	2325 PROCTOR VALLEY RD		TELEPHONE:	(619) 271-4385
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91914
CAPACITY:	105	CENSUS: 71	DATE:	12/05/2023
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Mchael Sokolowski, Executive Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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- Insufficient staff to respond to residents' call buttons timely

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver investigative findings regarding the above-mentioned allegation. LPA identified herself and was granted entry by Alyssa Antolin, concierge. LPA stated the purpose of the visit and reviewed the findings of the complaint with Executive Director Michael Sokolowski.

The Department’s investigation consisted of interviews with residents and staff, and records review of relevant documents pertinent to this investigation. On September 20, 2023, it was alleged that there were insufficient staff to respond to residents’ call button timely resulting in injuries.

Interview with residents did not coincide. Upon interviews, most residents did say that the staff response time once their call buttons were pushed were timely. One resident reported staff responding to call buttons untimely of about 20 minutes or not at all. None of the residents reported being injured in the process of staff response to their call buttons.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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-20230920152253

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: WESTMONT AT SAN MIGUEL RANCH	FACILITY NUMBER: 374603509
	VISIT DATE: 12/05/2023

NARRATIVE

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Staff interviews said that there are times when the residents accidentally take their devices with them out into the community which staff are unable to answer. A review of the facility’s activity records for the months of August 2023 and September 2023, there were five residents whose call button were over the time frame of 30 minutes. Submission of incident reports (IR) were reviewed for the months of August 2023 and September 2023. Upon review of the IR’s, there was only one incident report on file submitted to the San Diego Regional Office that reported resident sustaining an injury due to a fall, but according to the Device Activity Report, there was no call to the room. According to that IR the staff responded accordingly by contacting emergency response. In review of additional submitted reports, residents who sustained falls were taken to the hospital for further evaluation and treatment. None of the IR’s displayed major injuries due to staff untimely response of call devices.

Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff and outside source interviews, records reviewed, and LPA observations, there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be unsubstantiated.

The report was discussed, and an exit interview was conducted with Executive Director Michael Sokolowski. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Executive Director Sokolowski at the conclusion of the visit. The signature below confirms the receipt of these documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC9099 (FAS) - (06/04)

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