374604103-6-26-2024-08-AS-IESA-D6RMVU-20240701095720

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604103
Report Date: 06/26/2024
Date Signed: 06/26/2024 01:16:02 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
10/12/2020 and conducted by Evaluator Becky Kennedy

COMPLAINT CONTROL NUMBER: 08-AS-20201012093251

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:	06/26/2024
		UNANNOUNCED	TIME BEGAN:	10:48 AM
MET WITH:			TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility did not report incident to licensing.

INVESTIGATION FINDINGS:

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Licensing Program Analyst Becky Kennedy concluded the investigation which began on 10/14/2020.
The investigation into the above allegations consisted of interviews with internal sources, a review of internal documents, and a tour of the facility.
It was alleged that the facility did not report an incident to licensing. The investigation revealed that on 10/05/2020 facility administrative staff was made aware of an incident witnessed by at least two individuals that a care staff member was rough with a resident and pulled the resident’s hair. Licensing regulations require that any suspected physical abuse shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within twenty-four (24). This incident was not reported as required.
Based on the evidence obtained the allegation that the facility did not report an incident tolicensing is SUBSTANTIATED, meaning that there is a preponderance of the evidence proving that the alleged violation occurred. A copy of this report along with the Applicant/Licensee Rights (LIC9058 01/16) was mailed to the Licensee’s last mailing address on file via USPS mail

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: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

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
10/12/2020 and conducted by Evaluator Becky Kennedy

COMPLAINT CONTROL NUMBER: 08-AS-20201012093251

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:	06/26/2024
		UNANNOUNCED	TIME BEGAN:	10:48 AM
MET WITH:			TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff physically abused resident resulting in serious injury.
Staff did not report changes in resident's health.
Inadequate staffing to meet the needs of the residents.
Administrator falsifying records

INVESTIGATION FINDINGS:

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Licensing Program Analyst Becky Kennedy concluded the investigation which began on 10/14/2020.
The investigation into the above allegations consisted of interviews with internal and external sources, a review of documents, and a tour of the facility.

It was alleged that the facility staff physically abused Resident 1 (R1) resulting in serious injury.
The investigation revealed that R1 was found on the floor in their bedroom. R1 received medical attention and was diagnosed with a hip fracture. Interviews and a review of documents did not reveal any information to support the allegation that R1’s injury was caused by physical abuse.

Staff did not report changes in Resident 2’s (R2) health. The investigation revealed that R2 had the capacity to, and monitored their own blood pressure and alerting others if there was a concern. R2 alerted facility staff that their blood pressure was too low on two occasions.

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: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 08-AS-20201012093251

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: 06/26/2024

NARRATIVE

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R2 received medical attention on both occasions and surgery was scheduled to address the low blood pressure concern. R2 was unable to tolerate the surgery due to declining health and R2 was sent back to the facility on “comfort measures”. About a week later R2 passed away. The allegation is that R2’s medical concerns were not reported timely and R2’s wellbeing suffered as a result. The investigation revealed that R2’s responsible party and medical providers were aware of R2’s health concerns and R2’s conditions were thoroughly documented.

It was alleged that the facility had inadequate staffing to meet the needs of the residents. This allegation is that Resident 3 (R3) required assistance eating and there were not enough staff to feed R3. Interviews revealed that during this period, staff levels were concerning for the facility. Staff struggled to meet resident’s needs and periodically a resident’s shower was pushed to the next day. Per interviews showers were always provided at least every three days and as needed. Needs such as feeding were given a high priority and interviews did not reveal that R3 or other residents were not fed.

It was further alleged that the facility administrator was falsifying records by asking care staff to clear a request for care within ten minutes regardless of if care was provided or not. Interviews did not reveal evidence to support this allegation.

Based on the evidence obtained during the complaint investigation, these allegations are Unsubstantiated, meaning that there is not a preponderance of the evidence proving that the alleged violations occurred.
A copy of this report along with the Applicant/Licensee Rights (LIC9058 01/16) was mailed to the Licensee’s last mailing address on file 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: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 08-AS-20201012093251

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: 06/26/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/27/2024 Section Cited CCR 87211(c)	1 2 3 4 5 6 7	Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to... the licensing agency...within twenty-four (24) hours as required by Welfare and Institutions Code Section 15630(b)(1).	1 2 3 4 5 6 7	Facility is closed
	8 9 10 11 12 13 14	Interviews revealed that facility staff did not report an allegation of physical abuse to the licensing agency in the timeframe required, posing a potential risk to the health and safety of all of the residents 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: Icela Estrada	TELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky Kennedy	TELEPHONE: 619-672-5843
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

LIC9099 (FAS) - (06/04)

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