374604103-6-21-2024-08-AS-IESA-D6QPBC-20240630111006

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604103
Report Date: 06/21/2024
Date Signed: 06/21/2024 09:13:29 AM

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
12/29/2020 and conducted by Evaluator Becky Kennedy

COMPLAINT CONTROL NUMBER: 08-AS-20201229094321

FACILITY NAME:	SIENNA AT OTAY RANCH SENIOR LIVING		FACILITY NUMBER:	374604103
ADMINISTRATOR:	REBECCA WILLIAMS		FACILITY TYPE:	740
ADDRESS:	1290 SANTA ROSA DR		TELEPHONE:	(619) 550-4521
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91913
CAPACITY:	0	CENSUS: 0	DATE:	06/21/2024
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:			TIME COMPLETED:	09:32 AM

ALLEGATION(S):

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Facility failed to obtain medical care for resident.

INVESTIGATION FINDINGS:

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LPA Kennedy concluded an investigation into the above allegation that was begun on 1/8/2021.

The investigation included interviews with internal and external sources a virtual tour of the facility and a review of documents.

It was alleged that the facility failed to obtain medical care for resident.

The investigation revealed that during the period when facilities were limiting visits with residents due to COVID, two individuals presented at the facility requesting a visit with Resident 1 (R1). The individuals did not have an appointment and it was approximately 10:00 PM. Facility staff facilitated a window visit with R1. R1 was lethargic and family requested that 911 be called. R1 was admitted to the hospital with and tested positive for COVID.

Unsubstantiated

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: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

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-20201229094321

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: 06/21/2024

NARRATIVE

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The days before R1 was hospitalized, documents reveal that R1 was found on the floor with no visible injuries and R1 denied any discomfort. R1’s responsible party was apprized via phone message.

R1 was noted to have a significantly decreased appetite. Facility staff informed R1’s medical provider.

The night before the hospitalization R1 slept through the night without concerns.

The day of the hospitalization R1 received a shower from a care provider, and ate breakfast, had a video visit. R1’s vitals were taken and were within normal range at approximately 10:00 AM.

At 10:00 PM when the window visit took place, R1 was awakened form sleep and was not very responsive. R1’s vitals were taken and R1 had a fever and low blood pressure. 911 was called.

Based on interviews and a review of documents, the facility staff were monitoring R1’s well-being, alerted R1’s medical provider as to R1’s reduced appetite, and took R1’s vitals the morning R1 was hospitalized.
When R1 was awakened for the window visit, R1 did not become more alert prompting concern. Facility staff took vitals and 911 was called.

Based on interviews and documentation, the preponderance of evidence has not been met to determine that facility staff failed to obtain medical care for R1. This allegation is Unsubstantiated.

A copy of this report, along with Licensee Rights (LIC 9058 01/16), were mailed via U.S. mail to the last mailing address on file.

SUPERVISOR'S NAME: Icela Estrada	TELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky Kennedy	TELEPHONE: 619-672-5843
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC9099 (FAS) - (06/04)

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