374603509-1-30-2024-08-AS-LTEZ-D22249-20240131160334

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603509
Report Date: 01/30/2024
Date Signed: 01/30/2024 11:14:59 AM

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
07/13/2020 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20200713094709

FACILITY NAME:	WESTMONT AT SAN MIGUEL RANCH		FACILITY NUMBER:	374603509
ADMINISTRATOR:	NEWTON, RANDAL		FACILITY TYPE:	740
ADDRESS:	2325 PROCTOR VALLEY RD		TELEPHONE:	(619) 271-4385
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91914
CAPACITY:	105	CENSUS: 69	DATE:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Executive Director Michael Sokolowski		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are not providing residents with food
Staff did not meet the needs of incontinent resident (s)
Staff did not administer medications as prescribed
Facility staff falsified a document
Staff are not following residents care plan
Facility did not ensure that hazardous items were inaccessible to residents
Facility did not maintain comfortable temperature for residents
Facility staff failed to follow reporting requirements

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to deliver complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Michael Sokolowski.

Throughout the investigation, the Department requested pertinent records and conducted interviews with external and internal sources, including staff and residents.

It was alleged staff did not provide residents food. It reported to the Department staff would not assist residents with feeding, and often food trays were witnessed to be untouched. Interviews with internal and external sources revealed the facility used food trays to deliver food to residents during the COVID-19 Pandemic. These sources did not corroborate witnessing lack of assistance with feeding, nor witnessing undelivered food trays. It was also revealed staff had provided the resident in question with different options, including cultural food choices.
(See LIC 9099-C for continuation of report.)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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-20200713094709

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: 01/30/2024

NARRATIVE

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It was alleged staff did not meet the needs of an incontinent resident. It was reported to the Department residents were found with soiled incontinence briefs. Interviews with internal and external sources did not reveal any concerns regarding staff not providing incontinence care. Interviews did reveal some of the residents may have experienced an increase in bowel movements and this may have contributed to staff encountering residents with soiled briefs, but there were no concerns with lack of care. Additionally, there were no concerns with skin irritation, nor breakage due to lack of incontinence care.

It was alleged staff did not assist residents with prescribed medication and that staff falsified documents. It was reported to the Department facility staff had witnessed medications had been dispensed, documented as taken by resident, but instead placed in a medication cart. Interviews with internal sources did not recall witnessing any similar incidents, nor the staff not assisting residents with medication. External sources did not have any concerns with lack of medication assistance. The facility did not produce the records requested by the Department, as they were not readily available.

It was alleged Staff were not following a resident's care plan. It was reported to the Department staff had not assisted residents with showers. Interviews with internal and external sources did not corroborate staff were not assisting residents with showers, nor did they reveal any concerns with lack of assistance from staff. Interviews did reveal that during the time period in question, there were staff disagreements that had led to staff blaming each other. Records requested from the facility were not readily available for review.

It was alleged staff did not ensure hazardous items were inaccessible to residents. It was reported to the Department that a Salon in the Memory Care unit was not secured; therefore, chemicals and sharp items were accessible to residents. An interview with the Executive Director at the revealed the facility had addressed the concern about the door not locking properly. Interviews with internal and external sources did not corroborate chemicals, nor sharp items being accessible to residents. During a visit to the facility, the LPA witnessed the salon to be locked and used for Personal Protective Equipment storage. Additionally, the Reporting Party disclosed having photographs corroborating the door was unlocked. These photographs were not provided to the Department.

(See additional LIC 9099-C for continuation of report.)

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20200713094709

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: 01/30/2024

NARRATIVE

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It was alleged staff did not maintain a comfortable temperature for residents. It was reported to the Department staff left residents windows open at night. Interviews with internal and external sources did not reveal any concerns regarding staff leaving residents windows open. Staff would close windows at the residents’ requests. Additional interviews revealed residents had reported rooms may have been warm and management addressed this with the facility maintenance personnel. There was no evidence to corroborate windows were left open, nor that this resulted in residents having cold like symptoms.

It was alleged facility staff failed to follow reporting requirements. It was reported to the Department facility staff did not follow the facility's internal process of reporting concerns. External sources revealed some staff would report concerns to management team and would expect management to follow up with them when follow up was not required, or necessary.. Interviews with internal and external sources, including third party providers, did not reveal any concerns with lack of communication from staff.

Based on the evidenced obtained throughout the investigation, there was not a preponderance of evidenced to prove the alleged violations occurred, therefore, the allegations were unsubstantiated.

An exit interview was conducted with Michael Sokoloswky, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058), were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

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