374604065-4-23-2024-08-AS-SJAB-D4TQAM-20240430120011

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604065
Report Date: 04/23/2024
Date Signed: 04/23/2024 02:51:30 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
12/30/2020 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20201230093215

FACILITY NAME:	LAS VILLAS DE CARLSBAD		FACILITY NUMBER:	374604065
ADMINISTRATOR:	BLOOM, CHARLIE		FACILITY TYPE:	740
ADDRESS:	1088 LAGUNA DRIVE		TELEPHONE:	(760) 434-7116
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92008
CAPACITY:	214	CENSUS: 108	DATE:	04/23/2024
		UNANNOUNCED	TIME BEGAN:	09:49 AM
MET WITH:	Divinia Nunez		TIME COMPLETED:	02:59 PM

ALLEGATION(S):

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Staff did not communicate with resident's authorized representative of resident's change of health conditions.
Resident's hygiene needs were not met.
Staff did not safeguard resident's property.
Staff are mismanaging resident's medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano, conducted an unannounced Complaint Visit. LPA introduced himself and discussed the purpose of the visit with Regional Director of Operations Divinia Nunez.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of records review and interviews with facility staff, residents and outside sources.

It was alleged that facilty staff did not communicate with authorized representative of Resident 1 (R1) change of health conditions(an LIC 811 Confidential Names List was provided to the facility representative to identify the resident) Review of facility policy revealed that any changes in resident's condition witnessed by facility staff would be reported to the Licensed Nurse. The Licensed Nurse would evaluate the resident and would be responsible for notifying the resident's responsible party and physician if appropriate. Interview with Health Services Director (HSD) revealed at the moment a change of condition was known HSD would call the family right away.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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-20201230093215

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: LAS VILLAS DE CARLSBAD	FACILITY NUMBER: 374604065
	VISIT DATE: 04/23/2024

NARRATIVE

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HSD stated that she has no doubt that facility staff would have called R1's responsible party to advise of maintained that they adhered to the facility's protocols for communicating health changes with authorized representatives.

It was alleged that R1's hygiene needs were not met. Review of Facility policy revealed that residents would be scheduled to bathe a minimum of twice per week. If a resident resisted or refused the scheduled bath, repeated attempts would be made at intervals throughout the day and evening, by different staff members. Following each time a resident used the toilet, the perineal and buttocks area will be cleaned as necessary, utilizing appropriate personal cleaning products. It should be noted that above allegation was made during the Covid-19 pandemic which could have caused occasional delays in response to hygiene requests, but there was no evidence to support a systemic failure in meeting the resident's hygiene needs.

It was alleged that facility staff did not safeguard R1's property. Documentation was reviewed regarding the facility theft and loss program. Interview with Resident 2 revealed R2 has never had any items stolen. R2 stated R2 had not experienced staff not safeguarding resident property. No instances of negligence or mishandling of R1's property were identified during the investigation period.

It was alleged that staff mismanaged R1's medication. Review of medication management policy revealed the facility would make a reasonable effort to maintain a current list of all medications, including over the counter medications, being self administered by each resident, to be used in case of an emergency. Whenever a resident has a change in medication regime the resident should notify the facility so the staff may update their medication list. LPA interviewed Staff 1 (S1) who stated that whenever a resident moves out of the facility a "medication reconciliation" is conducted with the resident and/or responsible party depending on the residents capabilities. The medication is "counted back" to the responsible party. The responsible party acknowledges that they received the medication back and the quantities of medication.

Records review revealed the following; R1 was ambulatory, R1 was able to bathe self, R1 was able to administer own prescription medications and R1's physical health status was "good." R1 completed a mental status examination on April 17, 2019. R1 scored a 29 out of 30. R1 wrote on the last page of the exam; " I just took a test and found it very easy."

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20201230093215

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: LAS VILLAS DE CARLSBAD	FACILITY NUMBER: 374604065
	VISIT DATE: 04/23/2024

NARRATIVE

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Outside source (OS) statement dated April 4, 2019 indicated that OS was in support of R1 residing in "independent living" level of care. OS stated that R1 had been under their care since January 28, 2015 and OS had weekly contact with R1 regarding R1's mental health issues. OS stated that R1 was psychologically appropriate for independent living.

LPA interviewed Outside Agency (OA). OA stated that OA had no knowledge of any of the complaint allegations. OA further stated that OA has not witnessed any of the listed allegations.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid.

An exit interview was conducted with Divinia Nunez. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Divinia Nunez whose signature below verifies receipt of these rights.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC9099 (FAS) - (06/04)

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