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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603660
Report Date: 06/30/2022
Date Signed: 06/30/2022 01:57:16 PM

Unsubstantiated


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
07/09/2021 and conducted by Evaluator Rebecca A Ruiz
COMPLAINT CONTROL NUMBER: 08-AS-20210709083731
FACILITY NAME:BAYVIEW SENIOR ASSISTED LIVINGFACILITY NUMBER:
374603660
ADMINISTRATOR:JEFFREY SETTINERIFACILITY TYPE:
740
ADDRESS:3219 CANON STREETTELEPHONE:
(619) 225-5616
CITY:SAN DIEGOSTATE: CAZIP CODE:
92106
CAPACITY:17CENSUS: 16DATE:
06/30/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Maria FloresTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Licensee did not meet the needs of the resident, resulting in severe dehydration
Licensee did not meet the needs of the resident, resulting in severe malnutrition
Facility staff did not treat scabies
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint investigation visit to deliver findings regarding the above-mentioned allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Administrator Maria Flores.

The Department’s investigation consisted of interviews with staff, residents, and outside sources, review of records, and a tour of the facility. It was alleged that the Licensee did not meet the needs of the resident, resulting in severe dehydration and malnutrition. Record review and investigative interviews revealed that on 6/28/2021, Resident 1 (R1) was observed by facility staff to be weak and fainted during breakfast. R1 was admitted to the hospital and diagnosed with severe dehydration, severe malnutrition, a urinary tract infection, and scabies. Interviews with outside sources revealed that R1's spouse had passed away in April 2021 and R1 attended the funeral for their spouse in early June 2021.

Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
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 3
Control Number 08-AS-20210709083731
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: BAYVIEW SENIOR ASSISTED LIVING
FACILITY NUMBER: 374603660
VISIT DATE: 06/30/2022
NARRATIVE
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After the funeral, R1 was observed by staff and outside sources to be sleeping more and eating and drinking less. R1’s sibling also passed away in June 2021. Staff stated that in response to this behavior change, they gave R1 milk shakes and R1's choice of fast food and facility food. Record review revealed that starting in April 2021, facility staff were working with R1’s physician and home health services regarding R1’s decreased food intake and scheduled multiple medical appointments in May 2021. Interviews with staff also revealed that facility staff offered R1 water whenever staff interacted with R1 and R1 was able to drink unassisted. Onsite visits and interviews revealed R1 did not have any issues with the care R1 received at the facility and was offered drinks throughout the day and with meals. During onsite visits, R1 was observed with drinks and snacks. Review of medical documents from R1's hospitalization on 6/28/21 revealed that R1's weight was recorded on 6/28/2021 at 9:04am at 120 pounds and 5.9 ounces. On the same day at 9:31pm, R1's weight was recorded at 70 pounds and 12.3 ounces. Interviews with R1's primary physician stated that it appeared that R1's weight was entered in error due to the vast discrepancy in weight history. Interviews with facility staff and Licensee revealed that between late 2020 and April 2021, R1 lost approximately 40 pounds while living at another community care facility.

The Department’s investigation consisted of interviews with staff, residents, and outside sources, review of records, and a tour of the facility. It was alleged that facility staff did not treat the resident’s scabies. Review of fax documents between the facility and R1’s primary physician revealed that the facility was in communication with R1’s primary physician regarding R1’s skin conditions between 3/3/2020 and 7/2/2021. Interviews with outside sources revealed that R1 had a history of heat rashes. The facility contacted R1’s primary physician on 5/18/2020, 5/19/2020, and 5/23/2020 regarding R1’s shingles diagnosis and the care plans for treatment. On 5/20/2021, R1 attended a medical appointment where R1 was diagnosed with scabies and prescribed a topical cream and topical ointment. On the same day as the medical appointment, the facility contacted R1’s primary physician to notify them of R1’s scabies diagnosis. Facility staff applied a topical medication to treat the scabies, disinfected R1’s belongings, and increased the frequency of R1’s showers. On 6/28/2021, R1 was diagnosed with scabies at the hospital. The facility contacted R1’s primary physician, moved R1 to a new room, and cleaned and sanitized R1’s belongings and furniture. On or about 7/2/2021, R1 was not showing any improvement with the skin condition and the facility contacted R1’s physician to request updated care plans.

Continued on LIC9099-C Page...
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 08-AS-20210709083731
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: BAYVIEW SENIOR ASSISTED LIVING
FACILITY NUMBER: 374603660
VISIT DATE: 06/30/2022
NARRATIVE
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Investigative interviews revealed that R1 was treated for scabies and the facility’s physician had determined that R1’s scabies was not active and that scarring from the scabies could last for months. Interviews with outside sources and R1’s physician revealed that R1 was undergoing treatment for the scabies. R1’s physician also did not have any concerns about the care being provided at the facility.

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

An exit interview was conducted with Administrator Maria Flores, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3