<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603750
Report Date: 09/30/2021
Date Signed: 10/01/2021 03:34:09 PM



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
12/17/2019 and conducted by Evaluator Laarni Santiago
COMPLAINT CONTROL NUMBER: 08-AS-20191217083642
FACILITY NAME:CASA ALDEA SENIOR LIVINGFACILITY NUMBER:
374603750
ADMINISTRATOR:MAILLY, EVEFACILITY TYPE:
740
ADDRESS:14740 VIA FIESTATELEPHONE:
(858) 756-9600
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY:85CENSUS: 72DATE:
09/30/2021
UNANNOUNCEDTIME BEGAN:
02:58 PM
MET WITH:Joey Collado, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to address multiple falls for residents that resulted in minor injury
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Laarni Santiago conducted a subsequent visit to conclude the investigation and render findings on the above mentioned allegation. LPA was met by Administrator, Joey Collado and Resident Care Director, Beth Romeo, identified herself and was granted entry into the facility. As part of the investigation, the Department conducted interviews with relevant persons, reviewed records, and consulted with outside sources.

It was alleged that Resident 1 (R1) and Resident 2’s (R2) (R1, R2 – See Confidential Names List) sustained multiple falls that resulted in minor injuries due to facility neglect. Interviews and records revealed that R1 moved in the facility on November 1st, 2019. A review of facility incident reports indicate that R1 had a witnessed fall on November 29th, 2019 while being assisted by a staff and sustained a contusion to the right hand. Record states that R1 is non-ambulatory, suffers from a right-side paralysis and a fall risk. On December 4th, 2019, R1 had another witnessed fall while being assisted by a staff during toileting. Staff interviewed acknowledged and made aware of R1’s risk for falling with a one-person assist during toileting. However, there was no updated care plan to address or mitigate falls.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni SantiagoTELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
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-20191217083642
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: CASA ALDEA SENIOR LIVING
FACILITY NUMBER: 374603750
VISIT DATE: 09/30/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On September 17th, 2019, R2 was admitted to the facility as a fall risk and have private caregivers to assist in the daytime. A review of R2’s care plan dated September 19th, 2019 notes that they are a fall risk but are able to ambulate independently with a steady gait and need reminders in using a walker for safety. Since the last assessment made on September 19th, 2019, R2 suffered multiple falls in the facility during the period of September 19, 2019 to December 19th, 2019. The documented incident indicates that some of these falls, witnessed and/or unwitnessed, resulted in a minor injury. There was no updated care plan to document the frequent falls for R1 and R2, and no implemented fall plan to identify staff objectives to mitigate the falls. Based on interviews conducted and record reviews, it was determined that the facility did not take measures to address multiple falls for R1 and R2. Therefore, the allegation is found to be substantiated. This finding means that the preponderance of the evidence standard has been met and the allegation is valid. 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 Joey Collado, Administrator, and the Administrator was provided a copy of this report and Licensee Appeal Rights, via electronic mail, after conclusion of the visit. An electronic receipt of confirmation was requested to be sent to LPA upon receipt of the documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni SantiagoTELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20191217083642
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: CASA ALDEA SENIOR LIVING
FACILITY NUMBER: 374603750
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2021
Section Cited
CCR
87411(a)
1
2
3
4
5
6
7
Personnel Requirements – General: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs…

This requirement was not met based on evidence by: Based on interviews and
1
2
3
4
5
6
7
An in-service training will be performed with all staff regarding two-person assist. The Licensee will submit an in-service training to CCLD by POC due date, 10/25/2021.
8
9
10
11
12
13
14
records review, the facility failed to implement a plan or identify staff objectives to mitigate R1 and R2’s falls. This posed a potential health and safety risk to 1 out of 66 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: Simon JacobTELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni SantiagoTELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
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
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
12/17/2019 and conducted by Evaluator Laarni Santiago
COMPLAINT CONTROL NUMBER: 08-AS-20191217083642

FACILITY NAME:CASA ALDEA SENIOR LIVINGFACILITY NUMBER:
374603750
ADMINISTRATOR:MAILLY, EVEFACILITY TYPE:
740
ADDRESS:14740 VIA FIESTATELEPHONE:
(858) 756-9600
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY:85CENSUS: 72DATE:
09/30/2021
UNANNOUNCEDTIME BEGAN:
02:58 PM
MET WITH:Joey Collado, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility lacked the staffing to meet residents needs
Facility failed to notify responsible party of incidents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
It was alleged that the facility lacks staffing during the time period of September 2019 to December 2019. The staffing concerns were for the memory care unit, where R1 and R2 resided. A review of staff time sheets during the time period revealed that there were two to four staff that worked in the evening during NOC shift. Interviews with staff verified that there’s usually three caregivers and one med-tech during evening shifts. Interviews with staff also revealed that the Administrator at that time have increased staffing to four staff for each NOC shift; two staff on memory care and two staff for Assisted Living. During this time period, there were approximately 17 residents in memory care. Based on interviews conducted and records reviewed, there is no corroborating evidence to suggest that the facility lacked staffing

It was alleged that the facility failed to notify responsible party of incidents that occurred at the facility. On November 28th, 2019, R1 had a witnessed fall that resulted in a minor injury and facility notified the responsible party of the fall. Interviews conducted with outside source revealed that a few days after the fall, a bruise was observed on R1 and that this was not reported to their respective responsible party.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni SantiagoTELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20191217083642
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: CASA ALDEA SENIOR LIVING
FACILITY NUMBER: 374603750
VISIT DATE: 09/30/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
However, interviews conducted with staff revealed that they were not aware of any bruising. In addition, outside source reported that R2 have been observed with a minor injury on them from a fall. Furthermore, R2 reportedly complained of pain and have indicated that they have fallen. Interviews revealed that these fall incidents have also not been reported to their respective responsible party until the facility was confronted about them.

While the above listed allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are unsubstantiated.

An exit interview was conducted, and Joey Collado, Administrator, was provided a copy of this report and Licensee Appeal Rights, via electronic mail, after conclusion of the visit. An electronic receipt of confirmation was requested to be sent to LPA upon receipt of the documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni SantiagoTELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5