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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604019
Report Date: 11/13/2023
Date Signed: 11/13/2023 11:00:34 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
08/01/2022 and conducted by Evaluator Daniel Pena
COMPLAINT CONTROL NUMBER: 08-AS-20220801100505
FACILITY NAME:POINT LOMA ELDER CAREFACILITY NUMBER:
374604019
ADMINISTRATOR:GAURAV RATHIFACILITY TYPE:
740
ADDRESS:3941 LIGGET DRIVETELEPHONE:
(619) 255-6448
CITY:SAN DIEGOSTATE: CAZIP CODE:
92106
CAPACITY:6CENSUS: 6DATE:
11/13/2023
UNANNOUNCEDTIME BEGAN:
10:36 AM
MET WITH:Hugo Duran, CaregiverTIME COMPLETED:
11:25 PM
ALLEGATION(S):
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Staff did not treat resident with dignity
INVESTIGATION FINDINGS:
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On 11/13/2023, at about 12:00 PM, Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced facility visit to conclude a complaint investigation regarding the above-mentioned allegation. LPA identified himself and discussed the purpose of the visit and complaint conclusion with Hugo Duran, Administrator.

On 8/1/2022, CCLD received a complaint alleging a staff person did not treat a resident with dignity. The Department’s investigation consisted of LPA observation, document and video recording review, and interviews with residents, staff, and outside sources.

As a result of this investigation, LPA identified a former employee, later determined to be a person of interest in this complaint. LPA interviewed the former employee. The former employee said they lived at the facility but were off duty on 7/29/22. The former employee admitted to LPA they were involved in some type of physical confrontation with Resident 1 (R1). LPA asked the former employee if they picked up and threw R1 on to a bed. The former employee said they picked R1 up and carried them from the sliding glass
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
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 6
Control Number 08-AS-20220801100505
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: POINT LOMA ELDER CARE
FACILITY NUMBER: 374604019
VISIT DATE: 11/13/2023
NARRATIVE
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(Continued: LIC9099)

door to their room. The former employee denied throwing R1 onto the bed and said they “set” R1 down. The former employee said they did this because R1 tried to run their scooter through a sliding glass door.

Interviews with independent outside sources divulged that the former employee was impatient, had no people skills and lost their temper with residents. One outside source revealed that the former employee told them that they (former employee) were fired for physically assaulting a resident. The former employee said they lost their temper with a resident. In an interview with the former employee, they stated they resigned from employment with the facility in February 2023. The employee denied being terminated. Interviews revealed that facility management said the employee was “let go” but not due to circumstances associated with this complaint or any type of abuse to any resident.

The Department has investigated the complaint alleging staff did not treat R1 with dignity. Based on interviews, sufficient evidence was obtained that a former employee did not treat a resident with dignity. The allegation that staff did not treat a resident with dignity is Substantiated. This finding means that the preponderance of evidence standard has been met and the allegation is valid. Deficiencies have been cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and noted on the attached LIC9099-D.

An exit interview was conducted with Mr. Duran, and a copy of this report and Licensee/Appeal Rights (LIC 9058 01/16) were provided to Mr. Duran at the conclusion of the visit.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 08-AS-20220801100505
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: POINT LOMA ELDER CARE
FACILITY NUMBER: 374604019
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2023
Section Cited
CCR
80072(a)(3)
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Personal Rights - ...(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to...This requirement is not met as evidenced by:
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Subject employee was separated from employment with the facility in February 2023, removing the immediate threat. Licensee agreed to procure vendorized training on personal rights. Licensee will provide CCLD with the date for training by POC date of 11/15/2023 and complete the employee training and provide written proof by email or fax by POC date of 12/13/2023.
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Based on interviews, the licensee did not ensure a resident was free from corporal or unusual punishment…This posed an immediate safety risk to all 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) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
08/01/2022 and conducted by Evaluator Daniel Pena
COMPLAINT CONTROL NUMBER: 08-AS-20220801100505

FACILITY NAME:POINT LOMA ELDER CAREFACILITY NUMBER:
374604019
ADMINISTRATOR:GAURAV RATHIFACILITY TYPE:
740
ADDRESS:3941 LIGGET DRIVETELEPHONE:
(619) 255-6448
CITY:SAN DIEGOSTATE: CAZIP CODE:
92106
CAPACITY:6CENSUS: 6DATE:
11/13/2023
UNANNOUNCEDTIME BEGAN:
10:36 AM
MET WITH:Hugo Duran, CaregiverTIME COMPLETED:
11:25 PM
ALLEGATION(S):
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Staff physically assaulted resident resulting in injuries
Staff destroyed resident's personal belongings
INVESTIGATION FINDINGS:
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It was also alleged; staff assaulted a resident which resulted in injuries and destroyed their personal belongings. The Department’s investigation consisted of LPA observation, document and video recording review, and interviews with residents, staff, and outside sources.

Per an incident report received at CCLD, on 7/29/2022, R1 was transported to a hospital emergency department with skin tears on their arm and leg. On 8/5/2022, the facility submitted an incident report for the incident. Per the report, R1 was observed by staff complaining of injuries to their right hand and left thumb. Staff notified the facility administrator and cleaned R1’s wounds. The administrator called paramedics requesting them to transport R1 to the emergency room for treatment. R1’s hand was x-rayed but the incident report did not provide a diagnosis. The report indicated that R1 moved out of the facility and into a private residence on 7/31/2022.

During this investigation, LPA obtained and reviewed a video recording related to the incident on 7/29/23. In the video, R1, identified by an outside source, is seen sitting on their motorized scooter in the kitchen.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
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 6
Control Number 08-AS-20220801100505
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: POINT LOMA ELDER CARE
FACILITY NUMBER: 374604019
VISIT DATE: 11/13/2023
NARRATIVE
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(Continued: LIC9099-A)

R1's right forearm/wrist appears to be bleeding. The depiction of the video does not show how R1's arm and hand were injured but the injuries are consistent with the Incident Report sent to CCLD on 8/5/22.

During this investigation, a former employee was interviewed regarding their involvement in a physical conflict with R1 on 7/29/23. The former employee was in their bedroom on this day when they heard R1 and staff yelling. The former employee went to the kitchen to investigate the commotion. The former employee observed R1 sitting on their scooter near the stove. The former struck R1’s hand which then struck a wall. The former employee said they struck the resident’s hand because they thought R1 may burn themselves on the kitchen stove. The former employee denied injuring the resident.

Resident interviews did not produce corroboration for the allegation as no other residents were in the area. Residents advised LPA during interviews that R1 was difficult and disrespectful towards staff. None of the interviewed residents witnessed a staff person assault any resident or cause them injuries. The former employee later told an outside source that they admittedly lost their temper with a resident. The outside source did not say the former employee caused the injury to the resident. Per another outside source, R1 told them the former employee caused the injuries. However, the investigation produced no persons who witnessed any employee assault any resident.

It was also alleged that staff destroyed R1’s personal belongings. An outside source reported that a former employee took R1’s telephone from them to keep them from making calls outside of the facility. A former employee was interviewed but denied damaging or taking R1’s personal property from them.

Facility records were reviewed and indicated that R1 moved out of the facility and into a private residence on 7/31/2022. R1’s property was removed from the facility before the complaint was submitted. LPA reviewed R1’s facility records which noted that R1 had an electric scooter, walker, wheelchair and television. Staff interviews reported consistent denials that they damaged R1’s property.

The Department has investigated the complaint alleging staff assaulted R1 which resulted in injuries and destroyed R1’s personal belongings. Based upon conflicting statements and inconclusive records, insufficient information was obtained to corroborate the allegations. The Preponderance of Evidence
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 08-AS-20220801100505
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: POINT LOMA ELDER CARE
FACILITY NUMBER: 374604019
VISIT DATE: 11/13/2023
NARRATIVE
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(Continued: LIC9099-C)

Standard was not met. Therefore, the allegations are Unsubstantiated.

An exit interview was conducted with Mr. Duran, to whom a copy of this report and the Licensee's Rights (LIC9058 01/16) were provided via hard copy.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6