374603688-11-4-2020-08-AS-DPOL-BVV6YJ-20201130201334

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603688
Report Date: 11/04/2020
Date Signed: 11/04/2020 11:41:40 AM

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
01/23/2020 and conducted by Evaluator Elizabeth Hamilton

COMPLAINT CONTROL NUMBER: 08-AS-20200123113430

FACILITY NAME:	SAPPHIRE CHARDONNAY		FACILITY NUMBER:	374603688
ADMINISTRATOR:	NAGHIBI, ALI		FACILITY TYPE:	740
ADDRESS:	484 CHARDONNAY COURT		TELEPHONE:	(760) 539-7791
CITY:	SAN MARCOS	STATE: CA	ZIP CODE:	92069
CAPACITY:	6	CENSUS: 5	DATE:	11/04/2020
		UNANNOUNCED	TIME BEGAN:	10:47 AM
MET WITH:	Licensee, Ali Naghibi		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff delayed phone calls to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Hamilton, LPA Adam Hamer and Licensing Program Manager (LPM) Denise Powell conducted an unannounced visit to deliver findings for the above-mentioned allegation. LPA's and LPM identified themselves and were granted entry into the facility by Licensee, Ali Naghibi. LPM Powell explained the purpose of the visit and the elements of the complaint with the Licensee, Ali Naghibi.

The Department’s investigation included records review, and interviews with staff and outside sources.

It was alleged that on December 03, 2019, staff delayed phone calls to Resident 1 (R1 – See LIC 811 Confidential Names List). All interviews conducted established staff were interceding phone calls to R1. Regional Manager (RM) Icela Estrada and LPA Hamilton attempted to interview and interact with R1, but due to their medical condition, the interview was unsuccessful. LPA Hamilton interviewed Licensee and they reported that they never kept the phone away from any resident; however, interviews and outside sources revealed Licensee delayed R1’s phone calls until an outside source spoke with Licensee. A review of R1’s admission agreement confirmed that resident is guaranteed access to the telephone.

Substantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Tony Girolami	TELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020

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-20200123113430

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: SAPPHIRE CHARDONNAY	FACILITY NUMBER: 374603688
	VISIT DATE: 11/04/2020

NARRATIVE

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This Department investigated the allegation that the facility staff delayed resident access to the telephone. Based on interviews with staff, outside sources and records reviewed, the preponderance of the evidence standard has been met; therefore, the allegation has been deemed substantiated. A citation is being issued in accordance with California Code of regulations, Title 22, Chapter 1, Division 6 and listed on the LIC9099D and a plan of correction was developed with the Licensee.

An exit interview was conducted and a copy of this report, List of Confidential Names (LIC 811), LIC9099D, and Licensee/Appeal Rights (9058 01/16) were provided to Licensee.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20200123113430

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: SAPPHIRE CHARDONNAY	FACILITY NUMBER: 374603688
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/04/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/30/2020 Section Cited CCR 87468.1	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (14) To have reasonable access to telephones, to both make and receive confidential calls. The licensee may require reimbursement for long distance calls. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated they would continue to ensure unrestricted access of the phone to all residents. Licensee agrees to review the telecommunications policy within the admissions agreement with the entire staff. Licensee will provide the staff inservice confirmation by November 30, 2020.
	8 9 10 11 12 13 14	Based on interviews and records reviewed, Licensee did not allow R1 reasonable access to the telephone, to receive confidential calls. This poses a potential personal rights risk to one of the six residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020

LIC9099 (FAS) - (06/04)

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