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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604103
Report Date: 06/28/2024
Date Signed: 06/28/2024 04:15:52 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
10/26/2020 and conducted by Evaluator Becky Kennedy
COMPLAINT CONTROL NUMBER: 08-AS-20201026100623
FACILITY NAME:SIENNA AT OTAY RANCH SENIOR LIVINGFACILITY NUMBER:
374604103
ADMINISTRATOR:MENDEZ, RUBY GOMEZFACILITY TYPE:
740
ADDRESS:1290 SANTA ROSA DRTELEPHONE:
(619) 550-4521
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:0CENSUS: DATE:
06/28/2024
UNANNOUNCEDTIME BEGAN:
03:56 PM
MET WITH:TIME COMPLETED:
03:57 PM
ALLEGATION(S):
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Licensee did not ensure that resident changes in condition are documented
Licensee did not ensure that medications are stored locked and inaccessible to residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst Becky Kennedy concluded the investigation which began on 11/02/2020.
The investigation into the above allegations consisted of interviews, a review of documents, and a tour of the facility.

It was alleged that the licensee did not ensure that resident changes in condition are documented. The investigation revealed that facility staff were requested to document resident’s behaviors in a way as to minimize the seriousness of incidents. When a resident had a significant behavior, caregivers reported to the Medication Technicians (MedTech). The MedTechs would complete the reports. The investigation revealed that MedTechs would be asked not to use specific language and to rewrite reports. An incident where a resident physical endangered the wellbeing of facility staff might be changed to “resident was aggressive”. The investigation revealed that the purpose of the language change was to conceal the seriousness of resident’s behaviors form the licensing agency.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky KennedyTELEPHONE: 619-672-5843
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
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 3
Control Number 08-AS-20201026100623
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: 06/28/2024
NARRATIVE
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It was further alleged that Licensee did not ensure that medications are stored locked and inaccessible to residents in care. The investigation revealed that on multiple occasions MedTechs would leave dosing cups filled with medications in resident’s rooms without assisting the residents taking the medication. The medications were not taken immediately and often not taken at all. This left medication unlocked and unsupervised and accessible to residents.

Based on the evidence obtained during the complaint investigation, these allegations and Substantiated, meaning that there is 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 former Licensee’s last known mailing address via USPS mail.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky KennedyTELEPHONE: 619-672-5843
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20201026100623
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: 06/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/28/2024
Section Cited
CCR
87705(f)(2)
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87705 Care of Persons with Dementia
(f) (2) The following shall be stored inaccessible to residents with dementia: Over-the-counter medication … toxic substances....
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Facility is closed
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Interviews revealed that medications were left unattended in resident’s rooms, allowing access to persons with dementia posing an immediate risk to the health and safety all of the residents in care.
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Type B
06/29/2024
Section Cited
CCR
87207
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False Claims
No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility.
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Facility is closed
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Interviews revealed that reports of resident’s behaviors were minimized to mislead the agency posing a potential risk to the wellbeing or all of the residents in care.
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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 EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky KennedyTELEPHONE: 619-672-5843
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3