374604058-11-19-2024-08-AS-RCLK-DBJ9SU-20241130223806

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604058
Report Date: 11/19/2024
Date Signed: 11/19/2024 04:11:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
11/01/2024 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20241101102328

FACILITY NAME:	NIR COMMUNITY II		FACILITY NUMBER:	374604058
ADMINISTRATOR:	HUQ, RANA		FACILITY TYPE:	740
ADDRESS:	10935 JEFFREY COURT		TELEPHONE:	(858) 348-2017
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	6	CENSUS: 4	DATE:	11/19/2024
		UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Staff, Norman Suyat		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not meet resident's incontinence care needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to conclude a complaint investigation. LPA identified herself and discussed the allegation mentioned above with Staff, Norman Suyat.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff. It was alleged staff did not meet resident's incontinence care need. It was reported Resident #1 (R1) was instructed by the facility staff to use the restroom in their brief, when R1 asked to use the restroom. R1’s Physician’s Report dated 09/04/24 indicated R1 was non-ambulatory, had a diagnosis of a Major Neurocognitive Disorder, incontinent of bladder/bowel, assistance with feeding, and was receiving hospice services. R1’s Preplacement Appraisal dated 09/30/24 reflected R1 required total care assistance to include toileting and hoyer lift for transfers. Prior to moving into the facility, R1 had two (2) hip surgeries due to falls. R1 was residing at the facility recovering from the surgery. Staff interviews revealed R1 would scream in pain when placed on the toilet/commode, because of the surgery. R1 could not bear weight, therefore, the facility used a hoyer lift when transferring R1 to their wheelchair. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024

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-20241101102328

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: NIR COMMUNITY II	FACILITY NUMBER: 374604058
	VISIT DATE: 11/19/2024

NARRATIVE

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R1 had private caregivers prior to moving into the facility. The private caregivers would visit R1 at the facility but not provide care, just companionship and some feeding assistance. The facility staff were responsible for R1’s care needs. Staff denied telling R1 to use the restroom in their brief. There was an understanding R1 would not use the restroom as it was high risk and painful. Staff and outside source interviews confirmed R1 would scream loudly from pain when placed on the toilet/commode. The outside source that was responsible for overseeing R1’s care was at the facility twice a day Monday through Friday. They did not provide care, as it was the responsibility of the facility. The outside source interview confirmed R1’s incontinence needs were met, and observed R1 was kept clean, dry and changed regularly. The administrator’s interview indicated R1 was admitted to the facility with some skin issues and the facility was able to help resolve them by providing good incontinence care. Licensee also stated R1’s incontinence needs were met. R1’s Power of Attorney stated R1’s was well taken care of by the facility staff and R1’s incontinence care needs were met. R1’s interview was unsuccessful due to R1 passing away on 11/07/24 from health related issues.

During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Staff, Norman Suyat whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024

LIC9099 (FAS) - (06/04)

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