374603643-12-19-2023-08-AS-JLOT-CYXRRH-20231228121511

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603643
Report Date: 12/19/2023
Date Signed: 12/19/2023 03:50:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
12/11/2023 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20231211141521

FACILITY NAME:	ST. PAUL'S PLAZA		FACILITY NUMBER:	374603643
ADMINISTRATOR:	STRATMAN, KIM		FACILITY TYPE:	740
ADDRESS:	1420 E PALOMAR STREET		TELEPHONE:	(619) 591-0600
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91913
CAPACITY:	300	CENSUS: 149	DATE:	12/19/2023
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Assistant Administrator Maria Sano		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Licensee did not administer medication as prescribed.
Licensee did not meet resident's needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to initiate a complaint investigation and deliver findings regarding the above allegations. LPA introduced herself and disclosed the purpose of the visit to Assistant Administrator Maria Sano.

On 12/11/23 it was alleged that the Licensee did not administer medication as prescribed, and did not meet a resident's (R1) needs. The Department’s investigation consisted of an unannounced facility visit, review of relevant records, interviews with facility staff, residents, outside sources, and LPA direct observations.

Regarding the allegation, "Licensee did not administer medication as prescribed", it was alleged that the Licensee did not provide a medication to R1 within a specific timeframe. Staff interview revealed that the medication in question was a pro re nata (PRN) medication that was to be administered as needed based on R1's pain levels. Records review revealed that the resident was given the medication on the day in question as needed for pain, and within the prescription requirements.
(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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-20231211141521

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ST. PAUL'S PLAZA	FACILITY NUMBER: 374603643
	VISIT DATE: 12/19/2023

NARRATIVE

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(Continued from LIC9099)

Outside sources interviewed expressed no concerns with the way the facility administered medications and did not advise any known errors. The resident in question was unable to be interviewed.

Regarding the allegation, "Licensee did not meet resident's needs", it was alleged that staff did not check on Resident 1 (R1) during a specific timeframe. Staff interviews consistently revealed that R1 was checked on every 1-2 hours for incontinence care and due to being a fall risk, and that the door to R1's bedroom typically remained open. Staff interview further revealed that staff checked on R1 via a combination of walking into the room to speak with them, or observing them from the hallway. During the timeframe in question, staff interview revealed that R1 was observed to be sleeping and unable to be checked. Records review revealed that during the timeframe in question, R1 was also occupied with a visitation by an outside individual. Records review further revealed that R1 was consistently observed and/or checked on in 2-hour intervals. Outside sources interviewed did not express concern regarding R1's needs being met or R1 being monitored consistently for assistance. During an unannounced facility visit, LPA directly observed caregivers engaging with residents 1 on 1, and checking on residents in their rooms. LPA directly observed most resident room doors open with their beds being in view from the hallway. The resident in question was unable to be interviewed.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Assistant Administrator Maria Sano, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC9099 (FAS) - (06/04)

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