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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603643
Report Date: 01/24/2024
Date Signed: 01/24/2024 03:29:32 PM

Substantiated


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
01/20/2021 and conducted by Evaluator Becky Kennedy
COMPLAINT CONTROL NUMBER: 08-AS-20210120145516
FACILITY NAME:ST. PAUL'S PLAZAFACILITY NUMBER:
374603643
ADMINISTRATOR:STRATMAN, KIMFACILITY TYPE:
740
ADDRESS:1420 E PALOMAR STREETTELEPHONE:
(619) 591-0600
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:300CENSUS: 146DATE:
01/24/2024
UNANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:Maria SanoTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Facility staff yells at resident
Facility staff did not assist resident with toileting needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst Becky Kennedy concluded the investigation which began on 1/29/2021. LPA Kennedy made an unannounced visit to the above facility today and met with Maria Sano, Assistant Administrator. LPA advised her of the reason for today's visit and delivered the investigation findings on the above allegations.

The investigation into the above allegations consisted of interviews with internal sources, records reviews, and a tour of the facility.

It was alleged that Staff Member 1 (S1) (A list of confidential names was provided to the facility) yelled at Resident 1 (R1) and that S1 did not provide toileting assistance to R1.

The investigation revealed that S1 admitted that they get frustrated with R1. In interactions with R1, S1 would talk loudly. Some staff members that overheard these interactions reported that S1 yelled at R1.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 08-AS-20210120145516
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: ST. PAUL'S PLAZA
FACILITY NUMBER: 374603643
VISIT DATE: 01/24/2024
NARRATIVE
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S1 admitted that if R1 requested help doing something, S1 would not assist R1 if S1 believed that R1 could do it for themselves, this includes toileting. S1 stated that if R1 struggled for two or three minutes, then S1 would provide assistance. R1’s care plan includes staff assisting with all toileting needs.

The investigative findings are that the above allegations are Substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are cited on LIC 9099-D.

This report was discussed with Maria Sanos, Assistant Administrator. A copy of this report along with Licensee Rights (01/2016) was provided to facility staff at the conclusion of the visit.

SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20210120145516
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: ST. PAUL'S PLAZA
FACILITY NUMBER: 374603643
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/29/2024
Section Cited
CCR
87468.1(a)(1)
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Personal Rights - Residents …have all of the following personal rights: To be accorded dignity in their personal relationships with staff...
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S1 will be provided with training regarding communication with persons with dementia.
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Based on interviews and record review 1 of 124 residents was not accorded dignity in their personal relationships with staff when S1 yelled at R1 which posed a potential risk to the personal rights of persons in care.
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Type B
01/29/2024
Section Cited
CCR
87464(f)(4)
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Basic Services shall at a minimum include…assistance and care as needed by the resident and as indicated in the…appraisal, with those activities of daily living…
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S1 will be provided with training regarding caring for with persons with dementia.
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Based on interviews and record review the licensee did not provide care as needed to 1 of 124 persons in care when S1 did not provide prompt assistance to R1 which posed a potential risk to the health of persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
01/20/2021 and conducted by Evaluator Becky Kennedy
COMPLAINT CONTROL NUMBER: 08-AS-20210120145516

FACILITY NAME:ST. PAUL'S PLAZAFACILITY NUMBER:
374603643
ADMINISTRATOR:STRATMAN, KIMFACILITY TYPE:
740
ADDRESS:1420 E PALOMAR STREETTELEPHONE:
(619) 591-0600
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:300CENSUS: DATE:
01/24/2024
UNANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:TIME COMPLETED:
03:50 PM
ALLEGATION(S):
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3
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9
Facility staff hit resident causing injury
Facility staff threatened resident
Facility staff failed to report incident
INVESTIGATION FINDINGS:
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3
4
5
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7
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9
10
11
12
13
Licensing Program Analyst Becky Kennedy concluded the investigation which began on 1/29/2021. LPA Kennedy made an unannounced visit to the above facility today and met with Maria Sano, Assistant Administrator. LPA advised her of the reason for today's visit and delivered the investigation findings on the above allegations.

The investigation into the above allegations consisted of interviews with internal sources, records reviews, and a virtual tour of the facility.

It was alleged that Staff Member 1 (S1) hit Resident 1 (R1) leaving a bruise on R1’s arm/hand. It was further alleged that S1 threated a resident not to tell that they, S1 mistreated R1 and lastly it was alleged that the facility did not report incidents.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 08-AS-20210120145516
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: ST. PAUL'S PLAZA
FACILITY NUMBER: 374603643
VISIT DATE: 01/24/2024
NARRATIVE
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R1 was observed to have a bruise on their upper arm, how R1 came to be bruised in unknown. The bruise was first noted on a day S1 did not work, however S1 had worked the prior four days. The investigation revealed that ten potential witnesses were questioned, and none reported having any knowledge that S1 hit or threatened R1.

R1 has difficulty with their memory and was unable to provide information that was useful in the investigation.

The allegation about S1’s interactions with R1 were reported to facility management on January 18, 2020. On that date a Report of Suspected Dependent Adult/Elder Abuse for (SOC341) was completed and sent to Community Care Licensing and the Long-Term Care Ombudsman via fax and an Unusual Incident/Injury Report (LIC 624) was received in the Community Care Licensing office on January 19, 2020.

Based on the evidence obtained during the complaint investigation, the above allegations are UNSUBSTANTIATED, meaning there is not a preponderance of the evidence to prove that the alleged violations occurred.

This report was discussed with Maria Sanos, Assistant Administrator. A copy of this report along with Licensee Rights (01/2016) was provided to facility staff at the conclusion of the visit.
SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5