374603888-11-23-2022-08-AS-SJAB-CLP3EK-20221130171117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603888
Report Date: 11/23/2022
Date Signed: 11/23/2022 09:37:11 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
05/05/2021 and conducted by Evaluator Elizabeth Hamilton

COMPLAINT CONTROL NUMBER: 08-AS-20210505165730

FACILITY NAME:	A CARING HEART RESIDENCE		FACILITY NUMBER:	374603888
ADMINISTRATOR:	MONICA R. ALLAN		FACILITY TYPE:	740
ADDRESS:	371 E. MILLAN STREET		TELEPHONE:	(619) 585-4778
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	6	CENSUS: 3	DATE:	11/23/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Licensee, Monica Allan		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Resident was not provided an adequate amount of food

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced complaint investigation visit at the facility. LPA was greeted at the front entrance by Caregiver, Gloria LLanos and granted entry after identifying herself. LPA met with Licensee, Monica Allan and explained the purpose of the which was to deliver findings for the above allegation.

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

On May 05, 2021, it was alleged that resident 1 (R1) was not provided an adequate amount of food. It was alleged that R1 had lost around twenty pounds over the prior year and often stated they were hungry. Records reviewed revealed R1 had a diagnosis of dementia, was receiving dialysis and was a diabetic. Menus reviewed confirmed three adequate meals and snacks were provided daily. Interviews with staff and outside sources confirmed R1 frequently expressed they were “hungry”. Interviews with outside sources revealed R1 did not know when they were full and would overeat to the point of making themselves sick.

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: 11/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022

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-20210505165730

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: A CARING HEART RESIDENCE	FACILITY NUMBER: 374603888
	VISIT DATE: 11/23/2022

NARRATIVE

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Interviews with staff confirmed R1 was offered and provided three meals and three snacks a day. However, three days a week they would miss lunch, as they were at scheduled dialysis but would eat as soon as they returned between 3:00pm-4:00 pm. Interviews with other residents and outside sources confirmed there were no concerns with the amount of food that was provided during the time in question. On May 14, 2021, LPA observed residents including R1 eating lunch which included a variety of protein, carbohydrates, vegetables and fruit. LPA also observed enough food in the facility to serve six residents for a seven-day timeframe. There was no additional evidence provided during this investigation to support this 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. An exit interview was conducted with Licensee, Allan and a copy of this report and Licensee/Appeals Rights (LIC 9058 01/16) was provided.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022

LIC9099 (FAS) - (06/04)

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