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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604062
Report Date: 03/16/2023
Date Signed: 03/16/2023 10:38:17 AM

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
06/11/2020 and conducted by Evaluator Elizabeth Hamilton
COMPLAINT CONTROL NUMBER: 08-AS-20200611155908
FACILITY NAME:ELMCROFT OF POINT LOMAFACILITY NUMBER:
374604062
ADMINISTRATOR:KAREN ROPERFACILITY TYPE:
740
ADDRESS:3423 CHANNEL WAYTELEPHONE:
(619) 224-7300
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:60CENSUS: 39DATE:
03/16/2023
UNANNOUNCEDTIME BEGAN:
10:11 AM
MET WITH:Business Office Manager, Grace Ruiz and Executive Director, Kellie ShearerTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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9
Staff did not provide mattress cover to residents.
Staff stole resident’s medication.
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 Receptionist, Laura Cano and granted entry after identifying herself. Business Office Manager, Grace Ruiz and Executive Director, Kellie Shearer arrived during the visit. LPA explained the purpose of the visit which was to deliver findings for the above allegations.

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

On June 11, 2020, it was alleged that on or around the end of April 2020 and the beginning of May 2020, staff did not provide mattress covers to residents. Interviews with staff revealed that bedding was temporarily removed from multiple residents who had scabies, specifically during their infection period of a few days. Records reviewed confirmed former employee, staff 1 (S1 – See LIC-811 Confidential Names List) advised staff to remove residents bedding to avoid having the scabies cream rub off during their treatment.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
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 5
Control Number 08-AS-20200611155908
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: ELMCROFT OF POINT LOMA
FACILITY NUMBER: 374604062
VISIT DATE: 03/16/2023
NARRATIVE
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On June 11, 2020, it was further alleged that on or around the end of April 2020 and the beginning of May 2020, staff improperly accessed and used a resident’s topical cream medication, which was centrally stored. During the time in question, the facility self-reported that they had a scabies outbreak that spread between multiple residents and multiple staff and were diagnosed by a Physician. Interviews from outside sources and records reviewed confirmed during the time in question, S1 improperly gave staff 2 (S2) Permethrin Cream which was prescribed to resident 1 (R1). The medication was reportedly provided in order to treat S2’s scabies rash; however, the staff in question should have consulted with a medical provider regarding treatment and obtained their own prescription.

The Department has investigated the allegation of staff not providing mattress covers to residents and staff stealing a resident’s medication. Based on evidence obtained, the allegations are substantiated. A substantiated finding means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies are cited in accordance with California Code of Regulations, Title 22, Division 6 Chapter 8, and is listed on the 9099D.

An exit interview was conducted with Business Office Manager, Ruiz and a copy of this report, and Licensee/Appeals Rights (LIC 9058 01/16) was provided.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20200611155908
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: ELMCROFT OF POINT LOMA
FACILITY NUMBER: 374604062
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/23/2023
Section Cited
CCR
87307
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87307 Personal Accommodations and Services (3) … the licensee shall assure provision of: clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads…this requirement was not met as evidenced by:
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Business Office Manger stated all facility staff during the time in question received a personal rights training from an outside vendor. Verification of topics covered and sign in sheet will be provided to the department by 03/13/2023.
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Based on interviews and records reviewed the licensee did not ensure residents had mattress coverings. This posed a potential personal rights risk to 18 out of 46 residents in care.
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Type B
03/23/2023
Section Cited
CCR
87217
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87217 Safeguards for Resident Cash, Personal Property, and Valuables (b) Every facility shall take appropriate measures to safeguard residents' … personal property… which have been entrusted to the licensee or facility staff. This requirement was not met as evidenced by:
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Business Office Manager stated S1’s employment was terminated and all facility staff during the time in question received a Medication training from an outside vendor. Verification of topics covered and sign in sheet will be provided to the department by 03/23/2023.
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Based on interviews and records reviewed the licensee did not ensure resident medication was safeguarded from actions of staff S1. This posed a potential health risk to 1 out of 46 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: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
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
06/11/2020 and conducted by Evaluator Elizabeth Hamilton
COMPLAINT CONTROL NUMBER: 08-AS-20200611155908

FACILITY NAME:ELMCROFT OF POINT LOMAFACILITY NUMBER:
374604062
ADMINISTRATOR:KAREN ROPERFACILITY TYPE:
740
ADDRESS:3423 CHANNEL WAYTELEPHONE:
(619) 224-7300
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:60CENSUS: 39DATE:
03/16/2023
UNANNOUNCEDTIME BEGAN:
10:11 AM
MET WITH:Business Office Manager, Grace Ruiz and Executive Director, Kellie ShearerTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not allow residents in their rooms
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced complaint investigation visit at the facility. LPA was greeted at the front entrance by Receptionist, Laura Cano and granted entry after identifying herself. Business Office Manager, Grace Ruiz and Executive Director, Kellie Shearer arrived during the visit. LPA explained the purpose of the visit which was to deliver findings for the above allegation.

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

On June 11, 2020, it was alleged that on or around the end of April 2020 and the beginning of May 2020, staff did not allow residents in their rooms. Records reviewed revealed the facility self-reported a scabies outbreak during the time in question. Interviews with staff revealed the residents who contracted scabies were temporarily removed from their rooms, with their doors locked so the facility could disinfect the bedrooms, which took a few days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
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 5
Control Number 08-AS-20200611155908
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: ELMCROFT OF POINT LOMA
FACILITY NUMBER: 374604062
VISIT DATE: 03/16/2023
NARRATIVE
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7
8
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During that time, the residents in question were relocated to alternative rooms. There was insufficient evidence to support the allegation that staff did not allow residents in their rooms.

The Department has investigated the above allegation. Based on evidence obtained, including interviews and records reviewed, the allegation is determined as unsubstantiated as the Department could not meet the preponderance of the evidence standard.

An exit interview was conducted with Shearer and Ruiz and a copy of this report and Licensee/Appeals Rights (LIC 9058 01/16) was provided.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5