374603617-8-30-2022-08-AS-JRAE-CHU257-20220831170504

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603617
Report Date: 08/30/2022
Date Signed: 08/30/2022 11:25:41 AM

Unsubstantiated

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
04/07/2020 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20200407145738

FACILITY NAME:	BROOKDALE CARMEL VALLEY		FACILITY NUMBER:	374603617
ADMINISTRATOR:	MCDONALD, JASON		FACILITY TYPE:	741
ADDRESS:	13101 HARTFIELD AVE		TELEPHONE:	(858) 259-2222
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92130
CAPACITY:	125	CENSUS: 84	DATE:	08/30/2022
		UNANNOUNCED	TIME BEGAN:	10:52 AM
MET WITH:	Patricia Totorica		TIME COMPLETED:	11:36 AM

ALLEGATION(S):

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Facility staff did not allow resident to conduct counsel meetings.
Facility staff is not allowing visitors.
Facility staff discarded resident's personal food items.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with Business Office Director Patricia Totorica to whom LPA disclosed the reason for the visit.

Community Care Licensing (CCL) has investigated the above listed complaint allegations that were received on April 7, 2020. The investigation consisted of review of Provider Information Notices (PINs), facility and resident records, interviews with staff and residents.

On March 13, 2020 CCL PIN 20-07-ASC was provided to Adult and Senior Care facilites regarding the prevention, containment, and mitigation measures of the Coronavirus Disease. It should also be noted that in March 2020, California became the first state to order all residents to stay home with the exception of going to an essential job or shopping for essential needs. LPA interview with resident revealed no knowledge of resident counsel meetings being prohibited. Interview with facility staff revealed

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

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-20200407145738

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: BROOKDALE CARMEL VALLEY	FACILITY NUMBER: 374603617
	VISIT DATE: 08/30/2022

NARRATIVE

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resident counsel meetings were not prohibited but residents were asked to social distance and wear face masks. Staff believed there should be meeting minutes from that time period. Visitors were allowed inside of the facility during the time period of March and April 2020 with the exception of covid "outbreak" periods and then the visits would take place outside of the facility. All delivery drop-offs had a special covid procedure. Hot food items being delivered were immediately taken to the resident. All other items including mail and personal supplies underwent a decontamination process and were delivered to the resident the following day. In regards to personal food items that were thrown away; facility staff stated that during that time period any food items that were thought to be contaminated were usually discarded to prevent the spread of Coronavirus.

Interview with outside source on August 29, 2022 revealed the facility was being extremely cautious in regards to visits and any items being dropped off during that time period. They believe the precautions were in place to prevent the spread of Covid-19.

Interview with Director on April 10, 2020 revealed the facility was on alert 3X meaning no visitors were allowed except for essential visitors. The facility was still allowing companions to enter but at that time they had to be essential to the physical survival of the resident. The facility requested that perishable food not be delivered and if it was needed, the facility could provide the necessary items.

Based on interviews and records review, the preponderance of the evidence standard has not been met; therefore, the allegations are found to be unsubstantiated.

An exit interview was conducted with Patricia Totorica and a copy of this report and Licensee/Appeal Rights (LIC 9058 3/22) were provided to Patricia Totorica whose signature below confirms receipt of documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

LIC9099 (FAS) - (06/04)

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