374604062-10-27-2022-08-AS-IESA-CKR9NU-20221031233144

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604062
Report Date: 10/27/2022
Date Signed: 10/27/2022 02:56:52 PM

Unsubstantiated

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
12/21/2020 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20201221160822

FACILITY NAME:	ELMCROFT OF POINT LOMA		FACILITY NUMBER:	374604062
ADMINISTRATOR:	SHEARER, KELLIE		FACILITY TYPE:	740
ADDRESS:	3423 CHANNEL WAY		TELEPHONE:	(619) 224-7300
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92110
CAPACITY:	60	CENSUS: 45	DATE:	10/27/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Kellie Shearer, Administrator		TIME COMPLETED:	11:55 AM

ALLEGATION(S):

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-Lack of care and/or supervision resulted in a resident’s unwitnessed fracture while in care

INVESTIGATION FINDINGS:

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On 10/27/2022, at approximately 11:15 AM, Licensing Program Analyst (LPA) Daniel Pena, conducted an unannounced visit to the facility to conclude a complaint investigation. LPA was met at the entrance by Administrator, Kellie Shearer. After identifying himself and displaying his department identification, LPA was allowed inside the facility. LPA met with Ms. Shearer to whom the elements of the complaint were discussed.

It was alleged that lack of care and/or supervision resulted in a resident’s unwitnessed fracture while in care. The Department’s investigation consisted of facility visits, facility and outside source record reviews, and interviews with staff and outside sources.

Investigation revealed that on 12/19/2020, temporary personnel (Agency Staff) contacted Resident 1 (R1) in their bed. Interviews indicated that agency staff informed facility staff that R1 was complaining of pain to their right leg and not allowing staff to change their bedding.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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-20201221160822

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: ELMCROFT OF POINT LOMA	FACILITY NUMBER: 374604062
	VISIT DATE: 10/27/2022

NARRATIVE

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Other than timeframe variations, staff’s statements were consistent. Essentially, at about 9:30 AM, staff found R1 in bed complaining of pain but had no visible injuries. R1 did not know how or state how the injury occurred, nor did they say they fell. Staff stated that at no time did they see R1 on the ground or witness R1 fall. Interviews consistently stated that at some point, R1 went unconscious. Staff called 911. Prior to paramedics arriving, R1 regained consciousness and told staff they had pain the right hip area. When paramedics arrived, they questioned R1 as to how they were injured and R1 said they did not know. Paramedics transported R1 to the hospital. R1’s primary care physician and responsible party were notified.

Interviews and records later revealed R1’s right leg was fractured. R1’s pre-op diagnosis was noted as right Femur Orif Fracture. Records indicate that R1 received surgery on 12/20/20. Interviews stated that the incident was reported as a "suspicious injury" because the cause of injury was unknown nor was it witnessed. Despite interviews with staff and outside sources, no additional information was obtained to corroborate the allegation.

Facility records indicated that R1 had a prior fall while at the facility on 6/22/20. R1 was found by staff on the floor in a hallway, complaining of pain. Emergency medical services were summoned and R1 was transported to the hospital for evaluation and treatment. R1’s responsible party and primary care provider were notified. Records indicate that this incident too was not witnessed. No other information was provided.

The Department has investigated the allegation that lack of care and/or supervision resulted in a resident’s unwitnessed fracture while in care. Based on the information obtained during the course of this investigation, insufficient evidence was obtained to support the allegation. Therefore, the finding is determined to be Unsubstantiated. Although the allegation may have occurred or could be valid, there is not a preponderance of evidence to prove it occurred.

An exit interview was conducted with Administrator Shearer and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) were provided and Ms. Shearer’s signature on this form confirms receipt of these reports.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC9099 (FAS) - (06/04)

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