374603660-11-22-2022-08-AS-LTEZ-CLMRDS-20221129115624

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603660
Report Date: 11/22/2022
Date Signed: 11/22/2022 09:39:08 AM

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
08/13/2021 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20210813161627

FACILITY NAME:	BAYVIEW SENIOR ASSISTED LIVING		FACILITY NUMBER:	374603660
ADMINISTRATOR:	JEFFREY SETTINERI		FACILITY TYPE:	740
ADDRESS:	3219 CANON STREET		TELEPHONE:	(619) 225-5616
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92106
CAPACITY:	17	CENSUS: 15	DATE:	11/22/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Maria Flores		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Resident sustained unexplained weight loss
Resident is not provided adequate meals

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 House Manager Maria Flores.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, review of records, LPA observations, and a tour of the facility. It was alleged that a resident sustained unexplained weight loss and a resident was not provided with adequate meals. Interviews with residents revealed that residents did not have any complaints regarding the food being served. Residents stated that the facility served eggs, toast, and bacon for breakfast, served food like salads or sandwiches for lunch, and served food like hamburgers and chicken for dinner. During the initial visit on 8/23/2021, LPA Ruiz observed staff cooking scrambled eggs for breakfast.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

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-20210813161627

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: 11/22/2022

NARRATIVE

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Interviews revealed that the facility employed a dietitian who reviewed and created the food menu on a quarterly basis and staff would take resident preferences and family feedback into consideration when preparing meals. The staff also used a standing scale to weigh residents who were able to stand every month and would document any refusal of meals. Staff would notify residents’ physicians and responsible parties whenever a significant weight loss or gain was observed. Staff stated that a weight loss or gain requiring purchasing all new clothing would be considered a significant weight loss. Interviews revealed that around September 2021, resident 1’s (R1) spouse passed away at another assisted living facility. On September 8, 2021, staff observed that R1 had decreased food and liquid intake and they notified R1’s physician that R1 was refusing meals. On September 9, 2021, R1’s physician increased R1’s medication and noted that R1’s change in behavior could be connected to the passing of R1’s spouse. Review of R1’s needs and services plan dated September 10, 2021 revealed that staff were told to monitor R1 for changes in condition, ensure that a water cup was within R1’s reach, and redirect R1 as needed. Review of hospital records dated December 24, 2021 revealed that R1 had a weight loss of around 25 pounds in the last year and noted that it could have been attributed to R1’s history of cancer, diagnosis of dementia, medication prescribed for behaviors, and depression related to the death of R1’s spouse.

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

An exit interview was conducted with House Manager 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 Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

LIC9099 (FAS) - (06/04)

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