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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603884
Report Date: 10/29/2021
Date Signed: 10/29/2021 02:27:32 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
01/31/2020 and conducted by Evaluator Laarni Santiago
COMPLAINT CONTROL NUMBER: 08-AS-20200131130521
FACILITY NAME:RIGHT CHOICE SENIOR LIVING CLAIREMONTFACILITY NUMBER:
374603884
ADMINISTRATOR:TODD BROOKSFACILITY TYPE:
740
ADDRESS:4929 MOUNT LONGSTELEPHONE:
(619) 246-2003
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:6CENSUS: 5DATE:
10/29/2021
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Rosalie Asinas, CaregiverTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Staff failed to seek medical care after a resident sustained a hip fracture from a fall
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Laarni Santiago conducted an unannounced visit to conclude the investigation and deliver findings. LPA stated the purpose of the visit and spoke with Rosalie Asinas, Caregiver. The findings rendered are based on an investigation conducted by the Department. The investigation included a review of facility and medical records, as well as interviews conducted with staff, resident and outside sources.

It was alleged that the facility failed to seek medical care for Resident #1 (R1) (See LIC 811 – Confidential Names List) who fell and sustained a hip fracture.

On January 30th, 2020, R1 had a fall offsite while out with a friend. Interviews revealed that R1 believed they may have broken their hip because they heard a “crack” and felt immediate pain after the fall. Bystanders assisted R1 back to their wheelchair. According to R1, they requested the bystander to call 9-1-1 but revealed that none called for help. Therefore, R1 decided to take the public transportation back
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: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
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-20200131130521
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: RIGHT CHOICE SENIOR LIVING CLAIREMONT
FACILITY NUMBER: 374603884
VISIT DATE: 10/29/2021
NARRATIVE
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to the facility. Records indicate that R1 has hemiplegia, a paralysis on their left side of the body. Further evidence from facility records and interviews suggest that R1 is able to advocate for themselves, make their own decisions and able to communicate their needs. Evidence obtained from records and interviews revealed that R1 arrived back to the facility around 12:00PM; R1 reported to Staff 1 (S1) that they had a fall offsite, were in pain and requested to call an ambulance. S1 advised that they were instructed to get permission from the Administrator first before they could call for emergency medical services (EMS). Therefore, S1 called Administrator and left a voice message to report that R1 had a fall, was in pain, and requested for an ambulance. According to S1 and Administrator, they were aware that R1 was in pain but didn’t believe the pain was life threatening. Interviews conducted with Administrator revealed that they received the voice message from S1 around 1:00PM and it was when they discovered that R1 had a fall and sustained an injury. Around 1:40PM, R1 also contacted Administrator and left a message to report that they were in pain, however, Administrator did not receive the message until approximately 2:30PM. Subsequently, Administrator contacted R1’s family member to ask and determine which hospital to transport R1. Around 3:00PM, Administrator initiated EMS and around 3:20PM, R1 was transported to the hospital. Administrator acknowledged that there was a delay in requesting medical care due to awaiting a response from R1’s family member to which hospital to take R1. Evidence from medical records revealed that R1 sustained a left hip fracture from the fall.

Evidence from the investigation revealed that licensee failed to proactively take the appropriate steps to ensure that R1 received medical care when they expressed pain and requested for an ambulance. This agency has investigated the aforementioned allegation. Based on evidence obtained from interviews, records review, and outside sources, allegation is deemed substantiated due to the preponderance of the evidence standard been met. A citation is being issued in accordance with California Code of Regulations, Title 22, and listed on the 9099D.

An exit interview was conducted with the Administrator and a Plan of Correction was developed. A copy of this report and Appeal Rights (9058 01/16) were provided to the Administrator by electronic mail. A confirmation receipt was requested from the Administrator 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: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20200131130521
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: RIGHT CHOICE SENIOR LIVING CLAIREMONT
FACILITY NUMBER: 374603884
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
10/30/2021
Section Cited
CCR
87465(a)(1)
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Incidental Medical and Dental Care- A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical
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Administrator will communicate with all staff in the area of Incidental Medical Care, adhering to section cited by POC date.

Administrator will conduct training with all staff in the area of Incidental Medical Care will be conducted and show proof of completion by 11/08/21.
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and dental care appropriate to the conditions and needs of residents.
This requirement was not met based on evidence by: Based on records reviewed and interviews conducted, licensee did not arrange medical care appropriate to the condition and needs of R1. This posed an immediate health risk to 1 out of 3 residents 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: Simon JacobTELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni SantiagoTELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
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
01/31/2020 and conducted by Evaluator Laarni Santiago
COMPLAINT CONTROL NUMBER: 08-AS-20200131130521

FACILITY NAME:RIGHT CHOICE SENIOR LIVING CLAIREMONTFACILITY NUMBER:
374603884
ADMINISTRATOR:TODD BROOKSFACILITY TYPE:
740
ADDRESS:4929 MOUNT LONGSTELEPHONE:
(619) 246-2003
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:6CENSUS: 6DATE:
10/29/2021
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Rosalie Asinas, CaregiverTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Unlawful Eviction
INVESTIGATION FINDINGS:
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It was also alleged that Administrator refused to take R1 back to the facility since they would not be receiving rent for the room while they are admitted to the skilled nursing facility (SNF). Interviews conducted with Administrator revealed that R1’s rent payment is subsidized by the government and was advised by an Assisted Living Care Coordinator that R1 may lose their right to return to the facility if they are gone for more than 60 days. Administrator was advised by an outside source that R1 will be admitted to a SNF for approximately six to eight weeks. Therefore, Administrator advised R1’s representative to start working on placement but refuted the claim that R1 is being evicted and advised that they were welcome to return if the care coordinator allowed it. There was no written letter or evidence to suggest that R1 was being evicted.

While the above listed allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation of unlawful eviction is unsubstantiated.
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: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
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-20200131130521
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: RIGHT CHOICE SENIOR LIVING CLAIREMONT
FACILITY NUMBER: 374603884
VISIT DATE: 10/29/2021
NARRATIVE
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An exit interview was conducted, and 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: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5