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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603715
Report Date: 03/28/2024
Date Signed: 03/28/2024 03:17:15 PM

Substantiated


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
05/01/2023 and conducted by Evaluator Dawn Segura
COMPLAINT CONTROL NUMBER: 08-AS-20230501103744
FACILITY NAME:HARBORVIEW SENIOR ASSISTED LIVINGFACILITY NUMBER:
374603715
ADMINISTRATOR:SETTINERI, JEFFREYFACILITY TYPE:
740
ADDRESS:2360 ALBATROSS STREETTELEPHONE:
(619) 233-8382
CITY:SAN DIEGOSTATE: CAZIP CODE:
92101
CAPACITY:30CENSUS: 28DATE:
03/28/2024
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Jeffrey Settineri, AdministratorTIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Medications were not given as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigation findings. LPA was granted entry into the facility and met with Jeffrey Settineri, Administrator, to whom she disclosed the reason for the visit.

Community Care Licensing (CCL) has investigated the above-listed complaint allegation. The investigation consisted of a tour of the facility and interviews of facility residents and staff.

It was alleged that on 4/27/2023, Resident 1 (R1) [LIC 811 Confidential Names List was provided to identify the resident and staff] was not given his/her evening medications.

Interviews conducted during the investigation yielded that R1 was not administered two prescribed medications on the evening of 4/27/2023. There was no reason for the medications being missed, other than that staff did not administer the medications.

Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
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-20230501103744
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: HARBORVIEW SENIOR ASSISTED LIVING
FACILITY NUMBER: 374603715
VISIT DATE: 03/28/2024
NARRATIVE
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Accordingly, the allegation is substantiated. This finding means that the preponderance of the evidence standard has been met and the allegation is valid. The deficiency is cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and noted on the attached LIC 9099-D.

An exit interview was conducted with Jeffrey Settineri, Administrator, and copies of this report and Licensee/Appeal Rights (LIC 9058) were provided at the conclusion of the visit. Administrator's signature below serves as acknowledgment of receipt of copies of the report and rights.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
05/01/2023 and conducted by Evaluator Dawn Segura
COMPLAINT CONTROL NUMBER: 08-AS-20230501103744

FACILITY NAME:HARBORVIEW SENIOR ASSISTED LIVINGFACILITY NUMBER:
374603715
ADMINISTRATOR:SETTINERI, JEFFREYFACILITY TYPE:
740
ADDRESS:2360 ALBATROSS STREETTELEPHONE:
(619) 233-8382
CITY:SAN DIEGOSTATE: CAZIP CODE:
92101
CAPACITY:30CENSUS: 28DATE:
03/28/2024
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Jeffrey Settineri, AdministratorTIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Lack of supervision resulted in resident-on-resident altercation.

Resident was not provided food service.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigation findings. LPA was granted entry into the facility and met with Jeffrey Settineri, to whom she disclosed the reason for the visit.

Community Care Licensing (CCL) has investigated the above-listed complaint allegations. The investigation consisted of a tour of the facility, review of facility records, and interviews of facility residents and staff.

It was reported that on 4/27/2023, after dinner, 18-20 residents were left unsupervised in the dining room for at least an hour, during which time two residents were engaged in a minor altercation in which the two residents raised their voices and one resident swatted the arm of the other resident.


Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20230501103744
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: HARBORVIEW SENIOR ASSISTED LIVING
FACILITY NUMBER: 374603715
VISIT DATE: 03/28/2024
NARRATIVE
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It was also reported that, on the same date, R3, who receives meal service and feeding in their room, was not served his/her dinner meal.

Evidence obtained during the investigation did not yield evidence to corroborate either of the allegations listed above.

Based on the foregoing, the allegations are unsubstantiated. This finding means that although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Jeffrey Settineri, Administrator, and copies of this report and Licensee/Appeal Rights (LIC 9058) were provided at the conclusion of the visit. Administrator's signature on this report acknowledges receipt of copies of the rights and report.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20230501103744
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: HARBORVIEW SENIOR ASSISTED LIVING
FACILITY NUMBER: 374603715
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/11/2024
Section Cited
CCR
87465(c)(2)
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Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions.

This requirement was not met as evidenced by:
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Administrator provided proof of medication training attended by staff in October 2023 and on January 19, 2024.

Deficiency will be cleared during today's visit.
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Based on interviews, the licensee did not ensure that medication was administered according to physician’s directions to 1 of 26 residents (R1), which posed a potential health risk to 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.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5