374604079-6-19-2024-08-AS-SJAB-D6ER6V-20240620124523

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604079
Report Date: 06/19/2024
Date Signed: 06/19/2024 03:53:50 PM

Substantiated

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
02/29/2024 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20240229124243

FACILITY NAME:	WESTMONT OF LA MESA		FACILITY NUMBER:	374604079
ADMINISTRATOR:	GARCIA, KIMBERLY		FACILITY TYPE:	740
ADDRESS:	9000 MURRAY DR		TELEPHONE:	(619) 369-9700
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	164	CENSUS: 126	DATE:	06/19/2024
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Sabrina Priesman Executive Director.		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Facility staff failed to seek timely medical attention.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA Domingo introduced herself and disclosed the purpose of the visit tSabrina Priesman Executive Director.

It was alleged that Facility staff failed to seek timely medical attention for Resident 1 (R1), (Refer to LIC811 Confidential Names list). On January 18, 2023 R1 was being prepared to be transferred from the bed to the Geri Chair. Staff 1 (S1) turned away from R1 momentarily to move R1’s Geri Chair closer to the bed. When S1 turned, R1 rolled out of the bed on to the floor. S1 immediately called for assistance and R1 was assessed by Staff 2 (S2) who assessed R1 for injuries. Initially there were no visible injuries or complaints of pain.

(Continued on LIC9099C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

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-20240229124243

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: WESTMONT OF LA MESA	FACILITY NUMBER: 374604079
	VISIT DATE: 06/19/2024

NARRATIVE

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[Continued from LIC9099]

Outside Source (OS1) was called by phone to inform OS1 about the fall and OS1 instructed S2 to assist R1 from the floor and place R1 back in bed since there were no visible injuries or complaints of pain. Once R1 was back in bed, R1 exhibited signs of pain on the hip. S2 called back OS1 and S2 was instructed to give R1 pain medication.

On January 19, 2023 OS1 visited R1 at the facility. OS1 assessed R1 and determined that R1 was in pain. OS1 contacted Outside Source 2 (OS2) to discuss care options. OS2 elected to have R1 remain at the facility and have OS1 provide pain medications for R1's pain. Initially the pain medication provided relief but at some point, R1 was showing signs of pain once again.

From January 20, 2023 through January 23, 2023, OS2 observed R1 to be in more pain each day. Subsequently, OS2 asked for 911 to be called so R1 could be evaluated at the hospital. On January 23, 2023 Paramedics arrived and transported R1 to the hospital where R1 was diagnosed with a fractured pelvis.

R1 expressed pain from the time of the fall on January 18, 2023 to the time of the transfer to the hospital on January 23, 2023. R1 was able to express pain and the pain was not relieved by medication. The facility did not seek timely medical attention to address R1's expression of pain for 5 days.

The Department has investigated the above-mentioned allegation and based on interviews and records reviewed, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The deficiencies are cited in accordance with California Code of Regulations, Title 22 Division 6, Chapter 8 and noted on the attached LIC 9099-D.

An exit interview was conducted, plan of correction were reviewed and a copy of this report along with licensee Appeal Rights (LIC 9098 03/22) was given to Sabrina Priesman Executive Director whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20240229124243

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: WESTMONT OF LA MESA	FACILITY NUMBER: 374604079
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/19/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/27/2024 Section Cited CCR 87465(a)(1)	1 2 3 4 5 6 7	A plan for incidental medical care shall be developed by each facility. The plan shall encourage routine medical care and provide for assistance in obtaining such care by... The licensee shall arrange or assist in arranging for medical care appropriate to the conditions and needs or residents...	1 2 3 4 5 6 7	Executive Director agreed to have all staff (Clinical team) attend a CCL approved training on timely medical attention. Proof of training will be provided by POC due date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on interviews and records review, the licensee delayed medical attention for 1 of 126 resident that expressed pain for 5 days which posed an immediate health, safety or personal risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

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