374603617-2-16-2024-08-AS-SJAB-D2MVEZ-20240220152311

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603617
Report Date: 02/15/2024
Date Signed: 02/16/2024 08:46:20 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
01/12/2024 and conducted by Evaluator Mark Mandel

COMPLAINT CONTROL NUMBER: 08-AS-20240112115548

FACILITY NAME:	BAYSHIRE TORREY PINES		FACILITY NUMBER:	374603617
ADMINISTRATOR:	KIRBY, SCOTT		FACILITY TYPE:	741
ADDRESS:	13101 HARTFIELD AVE		TELEPHONE:	(858) 259-2222
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92130
CAPACITY:	125	CENSUS: 92	DATE:	02/15/2024
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Assistant Administrator Veronica Merlos and Residnent Services Director, Lizzie Dela Fuente Mistica		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff do not ensure infection control requirements are being followed
Staff do not allow residents to leave their rooms
Staff does not ensure adequate quality and quantity of food is served to residents in care
Staff do not ensure resident rooms are kept in clean, safe, sanitary conditions at all times
Staff do not ensure medications are dispensed in a safe manner to residents in care
Licensee does not ensure staff are in good health while providing care to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mark Mandel and Licensing Program Manager (LPM) Simon Jacob conducted an unannounced complaint visit to deliver findings on the above mentioned allegations and conclude the investigation that was initiated on 1/17/24. LPA and LPM identified themselves, met with and were granted entry by Resident Serivices Director, Lizzie Dela Fuente Mistica and were later joined by Assistant Administrator, Veronica Merols. During today's visit LPA and LPM toured the facility, conducted staff and resident interviews, observed residents in care and reviewed and obtained copies of facility records.

It was alleged that staff do not ensure infection control requirements are followed and that staff do not allow residents to leave their rooms. Based on the review of the facility's infection control/mitigation plan, interviews with residents, staff and outside sources, it was revealed that the facility was following their infection control plan. It was reported to the Department that the facility experienced an outbreak

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Mark Mandel	TELEPHONE: 619-990-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

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-20240112115548

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: BAYSHIRE TORREY PINES	FACILITY NUMBER: 374603617
	VISIT DATE: 02/15/2024

NARRATIVE

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beginning in the third week of December of 2023, which continued through the second week of January 2024. The positive residents were quarantined and communal dining and activities were suspended. However, evidence obtained did not reveal that non-positive residents were not allowed to leave their rooms or were quarantined or suspended from outdoor activities. Interviews revealed that protocols were followed, PPE was sufficient, and there were no staffing shortages.

It was alleged that staff does not ensure adequate quality and quantity of food is served to residents in care. LPA and LPM toured the kitchen and observed an ample food supply with a variety of foods. LPA and LPM observed the food menu and observed a variety of foods are served daily to include breakfast, lunch and dinner. Interviews conducted with residents and outside sources did not indicate issues with quality or quantity of food. It was alleged that staff did not ensure resident rooms are kept in clean, safe and sanitary conditions at all times. Interviews with residents, staff and outside sources did not indicate any issues with cleaning or sanitary conditions. It was alleged that staff do not ensure medications are dispensed in a safe manner to residents in care. LPA and LPM observed medications to be locked in a medication cart for all residents and did not observe any safety issues. It was also alleged that Licensee does not ensure staff are in good health while providing care to residents. Evidence obtained during the investigation did not indicate that staff were ill while working. Interviews conducted with staff indicated that staff would not come to work if sick and interviews conducted with residents and outside sources did not indicate that caregivers were coming to work sick.

Based on the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid. An exit interview was conducted with Resident Services Director, Lizzie Dela Fuente Mistica and Assistant Administrator, Veronica Merols. A copy of this report along with Licensee Rights (LIC 9058, 3/22) was provided to Resident Services Director, Lizzie Dela Fuente Mistica and Assistant Administrator, Veronica Merols. Administrator Merols' signature below verifies receipt of these rights.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Mark Mandel	TELEPHONE: 619-990-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC9099 (FAS) - (06/04)

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