374603625-11-21-2023-08-AS-DPOL-CY42LL-20231130162942

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603625
Report Date: 11/21/2023
Date Signed: 11/21/2023 01:53:55 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
10/18/2023 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20231018113626

FACILITY NAME:	STELLAR CARE		FACILITY NUMBER:	374603625
ADMINISTRATOR:	LINDA CHO		FACILITY TYPE:	740
ADDRESS:	4518 54TH STREET		TELEPHONE:	(619) 287-2920
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	120	CENSUS: 75	DATE:	11/21/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Brandon Cho, Acting Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff did not treat resident with dignity and respect
Staff did not meet resident's dietary needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to deliver investigative findings. LPA met with Administrator, Linda Cho and shared findings.

The Department investigated the above-listed complaint allegations. The investigation consisted of observations, a review of relevant records, and interviews with facility staff, residents, and outside sources.

On October 18, 2023, Community Care Licensing (CCL) received a complaint alleging that facility staff did not treat a resident (R1) with dignity and respect. [an LIC 811 Confidential Names List was provided to staff to identify the resident]. It was specifically alleged that on October 16, 2023, R1 communicated to an outside source that kitchen staff had told R1, they “needed to eat what they served” them “or starve”. ”. Additional details of when this alleged incident occurred, or which staff were involved, were not disclosed during the course of the investigation.
(Continue at LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

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-20231018113626

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: STELLAR CARE	FACILITY NUMBER: 374603625
	VISIT DATE: 11/21/2023

NARRATIVE

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(Continue from LIC9099)

During multiple interviews with staff, residents, and outside sources, it was consistently indicated that they had not witnessed any staff members mistreating R1 or any other resident living at the facility.

It was also alleged that staff did not meet R1’s dietary needs. It was specifically alleged that R1 was allergic to the food being served and that no alternative choices were being offered. A detailed review of R1’s medical records and service care plan indicated that R1 had a diagnosis of dementia. According to R1's medical records, R1 required a regular diet, and was gluten intolerant with allergies to three other food items. During multiple interviews, it was evident that staff were aware of R1’s dietary needs and took precautions necessary to ensure R1’s dietary needs were being met. R1’s allergies were highlighted in the kitchen area to ensure food handlers and servers adhered to R1’s dietary needs along with the other residents who had food allergies. On October 26, 2023, it was observed that the residents’ allergies were prominently displayed in the kitchen area for food handlers/servers to be able to follow during meal preparation. In addition, dishes were color-coded and separated according to food allergies, and the dining room tables that were designated to specific residents were labeled with the name of the resident and their food allergies. During multiple interviews with staff, it was indicated that due to R1's diagnosis, R1 would often get confused and indicate they were “diabetic” and were allergic to undocumented food items not on the prescribed list of allergies. During an interview, R1 indicated they were diabetic, and that staff insisted on serving food that did not meet R1’s diabetic restrictions. A review of R1’s medical records confirmed R1 did not have a diagnosis of diabetes. During interviews, staff indicated that alternative choices were offered to R1 if they did not like the meals on the menu that met their dietary needs. However, at times R1 would request food items that were on their allergy list and would get upset at staff for not providing the food item. Interviews with other residents with food allergies did not disclose any concerns regarding staff not meeting their dietary needs.

Based on record reviews and interviews with staff, residents, and outside sources, there was insufficient evidence to support the allegations in this report.

(Continue at LIC9099C)

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20231018113626

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: STELLAR CARE	FACILITY NUMBER: 374603625
	VISIT DATE: 11/21/2023

NARRATIVE

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(Continue from LIC9099C)

The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated.

An exit interview was conducted with Administrator, Linda Cho, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) was provided at the conclusion of the visit.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

LIC9099 (FAS) - (06/04)

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