374604051-8-2-2022-08-AS-LTEZ-CHTVNT-20220831163539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604051
Report Date: 08/02/2022
Date Signed: 08/02/2022 12:02:54 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
05/24/2022 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20220524151621

FACILITY NAME:	ATRIA RANCHO PENASQUITOS		FACILITY NUMBER:	374604051
ADMINISTRATOR:	HERNANDEZ, MARIANO QUINN		FACILITY TYPE:	740
ADDRESS:	12979 RANCHO PENSAQUITOS BLVD		TELEPHONE:	(858) 201-6458
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92129
CAPACITY:	120	CENSUS: 78	DATE:	08/02/2022
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Amy Buchanan		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Illegal Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint investigation visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Regional Director of Operations Amy Buchanan.

The Department’s investigation consisted of interviews, review of records, and a tour of the facility. It was alleged that the Licensee unlawfully evicted Resident 1 (R1). The Department was unable to interview R1. Interviews with outside sources revealed that R1 had a fall at the facility on or around late November 2021 and was transferred to a skilled nursing facility (SNF). On 12/28/2021, R1 had another fall at the SNF and was transferred to the hospital. Interviews with outside sources revealed that R1 tested positive for COVID-19 at the hospital on 12/28/2021 and 1/4/2022.

Continued on LIC9099-C page...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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-20220524151621

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: ATRIA RANCHO PENASQUITOS	FACILITY NUMBER: 374604051
	VISIT DATE: 08/02/2022

NARRATIVE

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Interviews with outside sources revealed that on 1/6/2022, a hospital case manager spoke to a representative of the facility who stated that R1 would not be allowed to return to the facility until R1 had a negative COVID-19 test result. Interviews with outside sources revealed that skilled medical professionals deemed that R1 was medically stable and was ready for discharge back to the facility. Interviews with outside sources revealed that R1 would be discharged back to the facility on 1/9/2022, if R1 tested negative. R1 continued to test positive on 1/9/2022, therefore, R1’s responsible party was forced to relocate R1 to a different residential care facility for the elderly. Interviews and records review confirmed that the Licensee did not provide R1 with a 30-day eviction notice. R1 was discharged to a different residential care facility for the elderly on 1/13/2022. Interviews and record review revealed that the facility received notice for R1 not returning to the facility on 1/15/2022.

The Department has investigated the above-mentioned allegation and based on observation, interviews, and record review, this allegation is deemed substantiated, which means that the preponderance of the evidence standard has been met and the allegation is valid. The following deficiency was cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page.

An exit interview was conducted with Regional Director of Operations Amy Buchanan, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20220524151621

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: ATRIA RANCHO PENASQUITOS	FACILITY NUMBER: 374604051
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/02/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/12/2022 Section Cited CCR 87468.2(a)(20)	1 2 3 4 5 6 7	87468.2 Personal Rights of Residents in Privately Operated Facilities (a)(20) to be protected from involuntary transfers, discharges, and evictions. A licensee shall not involuntarily transfer or evict residents for reasons other than those permitted by state law or regulations and shall comply with all eviction and relocation protections for residents.	1 2 3 4 5 6 7	Regional Director of Operations stated they will create a new policy requiring written approval from Regional Director of Operations and Corporate Nurse before refusing to readmit residents. Regional Director stated they will also conduct an in-service training on the
	8 9 10 11 12 13 14	This requirement has not been met as evidenced by: Based on interviews and record review, the Licensee did not ensure R1 was protected from eviction when R1 was not accepted back to the facility due to R1 testing positive for COVID-19. This posed a personal rights risk to R1.	8 9 10 11 12 13 14	new policy. Regional Director will provide LPA with a copy of the policy and in-service training sign in sheet by POC date.
	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: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

LIC9099 (FAS) - (06/04)

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