374604103-6-19-2024-08-AS-IESA-D6RNSJ-20240701104314

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604103
Report Date: 06/19/2024
Date Signed: 06/19/2024 01:52:16 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
10/05/2020 and conducted by Evaluator Becky Kennedy

COMPLAINT CONTROL NUMBER: 08-AS-20201005125116

FACILITY NAME:	SIENNA AT OTAY RANCH SENIOR LIVING		FACILITY NUMBER:	374604103
ADMINISTRATOR:	MENDEZ, RUBY GOMEZ		FACILITY TYPE:	740
ADDRESS:	1290 SANTA ROSA DR		TELEPHONE:	(619) 550-4521
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91913
CAPACITY:	0	CENSUS:	DATE:	06/19/2024
		UNANNOUNCED	TIME BEGAN:	11:02 AM
MET WITH:			TIME COMPLETED:	11:03 AM

ALLEGATION(S):

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Staff worker hit resident.
Resident's care needs are not being met.

INVESTIGATION FINDINGS:

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LPA Kennedy concluded an investigation into the above allegations that was begun on 10/14/2020.
The investigation included interviews and a review of documents.

It was alleged that a facility staff worker hit resident. Interviews and a review of documents revealed that multiple individuals had direct and/or indirect knowledge of at least one facility staff member who mistreated residents including physical hitting them.

It was further alleged that resident's care needs are not being met. Specifically, that the resident's toenails and fingernails are too long. Interviews revealed that care staff members identified concerns regarding a lack of foot care, specifically toenails that were long and required care. These concerns were reported to have been elevated and the facility did not provide, or arrange for proper care.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Icela Estrada	TELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky Kennedy	TELEPHONE: 619-672-5843
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-20201005125116

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: SIENNA AT OTAY RANCH SENIOR LIVING	FACILITY NUMBER: 374604103
	VISIT DATE: 06/19/2024

NARRATIVE

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The Department has investigated the above allegations and based upon the evidence obtained, it found that there is sufficient evidence to prove that both of the allegations occurred, meaning the preponderance of evidence standard has been met. Therefore, the allegations are determined to be Substantiated.

A copy of this report along with the Applicant/Licensee Rights (LIC9058 01/16) was mailed to former Licensee’s last known mailing address via USPS mail.

SUPERVISOR'S NAME: Icela Estrada	TELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky Kennedy	TELEPHONE: 619-672-5843
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)

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Control Number 08-AS-20201005125116

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: SIENNA AT OTAY RANCH SENIOR LIVING	FACILITY NUMBER: 374604103
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/19/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/20/2024 Section Cited CCR 87468.1(a)(3)	1 2 3 4 5 6 7	Residents in all residential care facilities for the elderly shall have all of the following personal rights:To be free from punishment, humiliation, intimidation, abuse...	1 2 3 4 5 6 7	Facility is closed
	8 9 10 11 12 13 14	Based on a review of documents and interviews at least one facility staff member mistreated at least one resident including hitting a resident posing an immediate risk to the health and safety to residents in care.	8 9 10 11 12 13 14
Type B 06/20/2024 Section Cited HSC 1569.2(c)	1 2 3 4 5 6 7	Care and supervision means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes…personal care.	1 2 3 4 5 6 7	Facility is closed
	8 9 10 11 12 13 14	Based on interviews the licensee did not ensure that proper foot care was provided to any of the residents in memory care which poses a potential health risk to residents in care.	8 9 10 11 12 13 14

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: Icela Estrada	TELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky Kennedy	TELEPHONE: 619-672-5843
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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