374603618-8-3-2021-08-AS-DPOL-CG3MES-20220706093310

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603618
Report Date: 08/02/2021
Date Signed: 08/03/2021 01:04:12 PM

Substantiated

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
08/21/2020 and conducted by Evaluator Evangelica Torres

COMPLAINT CONTROL NUMBER: 08-AS-20200821104211

FACILITY NAME:	BROOKDALE CARLSBAD		FACILITY NUMBER:	374603618
ADMINISTRATOR:	HIGHTOWER, SASHA		FACILITY TYPE:	741
ADDRESS:	3140 EL CAMINO REAL		TELEPHONE:	(760) 720-9898
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92008
CAPACITY:	125	CENSUS: 75	DATE:	08/02/2021
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Executive Director Bill Adams,		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Licensee failed to meet Resident's care needs
Insufficient staffing

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Eva Torres conducted a visit to deliver findings on the above allegations. LPA identified herself, spoke with Executive Director Bill Adams, and disclosed the purpose of the visit. The investigation included multiple interviews and a review of records.

It was alleged that insufficient staffing led to not meeting resident’s care needs.

On October 14, 2015, Resident #1 (See LIC 811- Confidential Names List for R1) was admitted to the facility. A review of R1’s records revealed that R1 requires and is receiving assistance with bathing, grooming, toileting, and medication.

On May 21, 2021, at approximately 09:29 PM, R1 activated their alert button. At 10:10 PM, staff responded to the alarm.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Evangelica Torres	TELEPHONE: (619) 900-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2021

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-20200821104211

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 CARLSBAD	FACILITY NUMBER: 374603618
	VISIT DATE: 08/02/2021

NARRATIVE

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In reviewing the facility’s records, including but not limited to staff schedules and resident's physician reports, care plans, as well as outside agency's records from the assisted living and memory care unit from August 2020 through May 2021, the records were found to be consistent except for the call alert log dated May 21, 2021. According to the call alert log dated May 21, 2021, it showed that it took staff fifty-five minutes to respond to R1’s call for assistance. In reviewing staff schedules, it was found that two staff had called off that night, which led to the inadequate staffing numbers in meeting resident’s care needs.

Though staff and resident’s interviews were found to be inconsistent in supporting the allegations, staff did acknowledge the delay in responding to R1’s call for assistance on May 21, 2021 due to insufficient staffing. R1 was also interviewed and their interview was consistent with the review of the call alert log for May 21, 2021.

Based on the review of records and interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is SUBSTANTIATED. California Code of Regulations (Title 22, Division 6), deficiencies are cited on the attached LIC 9099D.

An exit interview was conducted with Director Bill Adams, and their signature on this report was obtained. The Licensee/Appeal Rights (LIC 9058 01/16) and a copy of this report was emailed to them. A return email from the Director will confirm receipt of documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Evangelica Torres	TELEPHONE: (619) 900-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2021

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20200821104211

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 CARLSBAD	FACILITY NUMBER: 374603618
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/02/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/13/2021 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	Personnel Requirements - General: Facility personnel shall at all times be sufficient in numbers and competent to provide the services necessary to meet resident needs.	1 2 3 4 5 6 7	The Director informed the LPA that they change ownership of the facility and conducted a wage analysis of their employees, which resulted in an increase in their wages. The facility hired additional staff and assign care staff certain number of residents to enure resident's needs are met. LPA obtained proof of the above. This POC was cleared during the visit.
	8 9 10 11 12 13 14	Based on records reviewed and interviews, the licensee did not ensure sufficient care staff worked on May 21, 2021, which posed a potential safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Evangelica Torres	TELEPHONE: (619) 900-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2021

LIC9099 (FAS) - (06/04)

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