374603792-7-12-2022-08-AS-DPOL-CGSNXV-20220729105142

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603792
Report Date: 07/12/2022
Date Signed: 07/12/2022 08:24:49 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
04/17/2020 and conducted by Evaluator Elizabeth Hamilton

COMPLAINT CONTROL NUMBER: 08-AS-20200417163323

FACILITY NAME:	OAKMONT OF PACIFIC BEACH		FACILITY NUMBER:	374603792
ADMINISTRATOR:	ROXANNE GOODING		FACILITY TYPE:	740
ADDRESS:	955 GRAND AVE		TELEPHONE:	(858) 373-9300
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92109
CAPACITY:	0	CENSUS: 0	DATE:	07/12/2022
		UNANNOUNCED	TIME BEGAN:	08:18 AM
MET WITH:	Report mailed to Licensee		TIME COMPLETED:	08:26 AM

ALLEGATION(S):

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Licensee did not meet the needs of residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Hamilton sent this report to the former licensee's last known mailing address via USPS certified mail to deliver the investigation findings for the above allegation. This facility ceased operations on July 14, 2020.

The Department’s investigation consisted of record reviews, and interviews with staff and outside sources.

On April 17, 2020, it was alleged that on multiple dates in April 2020, licensee did not meet residents care needs. On April 9, 2020, at 8:00 am, it was alleged that Resident 1 (R1) was found on the floor next to their bed. It was further alleged on April 12, 2020, at around 9:30 am, Resident 2 (R2) was found on the floor next to their bed after they were heard calling for help. Both residents were assessed with no injuries noted and no staff witnessed the falls.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

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-20200417163323

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: OAKMONT OF PACIFIC BEACH	FACILITY NUMBER: 374603792
	VISIT DATE: 07/12/2022

NARRATIVE

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Interviews with staff and outside sources revealed that both R1 and R2 who lived in assisted living were diagnosed with COVID-19. On April 3, 2020 and April 6, 2020, they each were temporarily relocated from their regular living quarters to a designated two-bedroom apartment at the facility to isolate for 14 days due to positive COVID-19 status. Records reviewed confirmed the temporary relocation and the COVID-19 diagnoses. One staff was assigned to work in the designated COVID-19 isolation apartment with R1 and R2 per each twelve-hour shift per twenty-four-hour period. The assigned staff was stationed in the living room portion of the apartment, while R1 and R2 were in their own separate bedrooms with the doors open to allow observation. The staff was available to assist with both residents needs as staff were not to leave the isolation area during their twelve-hour shift. Records reviewed confirmed R2 was admitted to hospice on April 13, 2020, the day after the fall incident, due to an unrelated change of health condition. There were no documented observations of no suspected neglect or unmet care needs. During the time in question the assigned staff members were an employee of the facility or contracted from a staffing agency. A statewide waiver included in Provider Information Notice (PIN) 20-09 CCLD, dated April 2, 2020 permitted staff to start caregiving as soon as they provide proof of completion of first aid training and universal, droplet, and any other precautions as mandated by Center for Disease Control (CDC) guidelines. Interviews with outside sources revealed there were no concerns with the care for R1 or R2 during the timeframe in question. Although there were conflicting statements by staff and outside sources regarding whether or not R1 and R2’s needs were being met, there was insufficient evidence to support the allegation.

The Department has investigated the allegation listed above. Based on evidence obtained, including interviews and records reviewed, the above allegation is determined to be unsubstantiated as the Department could not meet the preponderance of the evidence standard.

A copy of this report, and appeals rights (LIC 9058 1/16) were sent to the licensee's last known address on record via USPS certified mail due to facility closure.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

LIC9099 (FAS) - (06/04)

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