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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604062
Report Date: 09/10/2021
Date Signed: 09/10/2021 11:58:14 AM



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
06/19/2020 and conducted by Evaluator Adam Hamer
COMPLAINT CONTROL NUMBER: 08-AS-20200619154203
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: 44DATE:
09/10/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Silvia Olague, Medication TechnicianTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff did not treat resident for scabies per physician's instructions.
Resident was involuntarily isolated.
Facility did not provide bed linens for resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Adam Hamer conducted an unannounced complaint investigation visit on today’s date. LPA arrived at the facility and, after identifying himself and discussing the purpose of the visit, which was to deliver findings for the above allegations, he was granted entry. LPA then met with Medication Technician Silvia Olague to deliver the findings.

The Department’s investigation included interviews with staff and outside sources. Facility records and outside medical records were also obtained by the Department and reviewed for pertinent evidence.

The Department received a complaint on June 19, 2020 alleging that staff did not treat resident for scabies per physician’s instructions, that a resident was involuntarily isolated, and that facility did not provide bed linens for resident. Interviews with staff, outside sources and a records review revealed that in May and June 2020, Resident #1 (R1)(See Confidential Names List – LIC 811) was a resident at the facility and on hospice care. Department interviews and records review revealed that R1 was diagnosed with scabies at that time and their doctor had ordered medication. Interviews
(cont. on 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Adam HamerTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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 4
Control Number 08-AS-20200619154203
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: 09/10/2021
NARRATIVE
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with staff were inconsistent as to the administration of R1’s medication. However, interviews with outside source medical professionals revealed that facility staff were not administering the medication as per the doctor’s order. Also, outside sources confirmed that the doctor left the order with staff #1 (S1)(See LIC 811) and the facility could not provide any record of the order from R1’s medical chart to the outside source. The Department was unable to interview R1 who had passed away of natural causes in September 2020. The Department was also unable to interview other residents who may have been present at the time of the incidents, due to cognitive impairment.

Outside source medical records confirmed the scabies diagnosis and the physician’s orders. Interviews with outside source medical professionals and medical records review revealed that facility staff had not been administering the medication per the doctor’s orders and that R1 continued to have active symptoms of scabies through the month of June and into late July 2020. After the scabies problem was controlled in August 2020, R1 transferred out of the facility to another facility.

With regard to the allegations of R1 being involuntarily isolated and not having bed linens, interviews with outside sources revealed that the facility placed R1 in a room by themselves, for a period of approximately two weeks, during June 2020. During this period, outside sources observed that R1 had a bed in their room with no night stand, chest of drawers or personal items. They also observed R1 on the bed with no sheets or any other coverings on more than one occasion. A review of facility records also revealed that R1 was on the “Residents in Isolation” section of the facility’s roster for the month of June 2020. Facility staff witnesses could not provide the Department with information as to why R1 was isolated during this time or why no bed linens were provided.

Based on the evidence obtained from staff and outside source interviews, and from facility and medical records review, the allegations that facility did not treat resident for scabies per physician's instructions, that a resident was involuntarily isolated, and that facility did not provide bed linens for resident are found to be SUBSTANTIATED, as there is a preponderance of the evidence to prove that the allegations occurred. Deficiencies are being cited in accordance with California Code of Regulations, Title 22, and are listed on the LIC 9099D, along with the plan of correction that was jointly developed by Silvia Olague and LPA

An exit interview was conducted with Ms. Olague, and a copy of this report, the LIC 9099D, the LIC 811 and Licensee/Appeal Rights (LIC 9058 FAS 01/16) were provided to her via email; she confirmed that she would send a confirmation email upon receipt of these documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Adam HamerTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 08-AS-20200619154203
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: 09/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/08/2021
Section Cited
CCR
87465(c)(2)
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(c) [...] facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions.

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Administrator will conduct training with all staff in the area of Medication Administration, and show proof of completion by the POC due date.
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This requirement was not met as evidenced by:
Based on records review and interviews, facility staff did not administer medication according to physician’s instructions which posed a potential health risk to 1 out of 44 residents in care.
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Type B
10/08/2021
Section Cited
CCR
87468.2(a)(8)
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(a) ...residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(8) To be free from...involuntary seclusion...
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Administrator will conduct training with all staff in the area of Residents' Personal Rights, and show proof of completion by the POC due date.
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This requirement was not met as evidenced by:
Based on records review and interviews, facility staff did not allow R1 to be free from involuntary seclusion, which posed a potential personal rights risk to 1 out of 44 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: Adam HamerTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20200619154203
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: 09/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/08/2021
Section Cited
CCR
87307(a)(3)(C)
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(a) ...the following provisions shall apply: (3) ...the licensee shall
assure provision of: (C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow
cases, mattress pads, ...The quantity shall be sufficient...to ensure that clean linen is in use by residents at all times.
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Administrator will conduct training with all staff in the area of Personal Accomodations and Services, and show proof of completion by the POC due date.
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This requirement was not met as evidenced by:
Based on outside source interviews and observations, facility staff did not provide R1 with clean linens at all times which posed a potential health risk to 1 out of 44 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: Adam HamerTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4