374604103-12-6-2023-08-AS-SJAB-CYVVNQ-20231226153529

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604103
Report Date: 12/06/2023
Date Signed: 12/06/2023 03:47:08 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
09/21/2020 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20200921125348

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: 0	DATE:	12/06/2023
		UNANNOUNCED	TIME BEGAN:	01:53 PM
MET WITH:	Facility Closed- Report Mailed to Address on File		TIME COMPLETED:	01:54 PM

ALLEGATION(S):

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Carpet has stains
Facility is malodorous

INVESTIGATION FINDINGS:

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On 12/6/2023, Licensing Program Analyst (LPA) Daniel Pena sent this report to the Licensee's last known mailing address, via USPS certified mail, to deliver the investigation findings for the above-listed allegations. The facility closed/changed ownership on 8/25/2021.

Community Care Licensing (CCL) investigated the allegations identified above. The investigation consisted of a virtual tour of the facility and interviews with facility staff and outside sources.

It was reported to CCL that the Memory Care area had strong urine odors and stains on its carpets. It was alleged that the facility did not clean effectively or replace the carpet. Based on LPA interviews, sufficient evidence was obtained to conclude that the facility had been maintained in an unkempt manner.

In an interview with the facility administrator, they acknowledged housekeeping staff did not follow through with cleaning nor did they utilize carpet cleaning machines purchased for this sole purpose. Interviews also revealed that a maintenance staff person was relieved of duty because of their ineffective

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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-20200921125348

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SIENNA AT OTAY RANCH SENIOR LIVING	FACILITY NUMBER: 374604103
	VISIT DATE: 12/06/2023

NARRATIVE

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cleaning of the malodorous and stained carpets.

Based on interviews, including an admission by the facility administrator, corroborating statements were obtained which provided support for the allegations.

The Department has investigated the above-mentioned allegations and obtained sufficient evidence to corroborate them. Therefore, the allegations are Substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met.

A Deficiency was cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on LIC 9099-D. The facility closed on 8/25/2021.

A copy of this report, LIC 9099D, Confidential Name List (LIC 811), along Licensee/Appeal Rights (LIC 9058 03/22) were mailed to the last known address on file.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20200921125348

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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: 12/06/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/25/2021 Section Cited CCR 80087(a)	1 2 3 4 5 6 7	Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	POC cleared as evidenced by facility closure. The facility closed on 8/25/2021.
	8 9 10 11 12 13 14	Based on interviews the licensee did not provide sanitary conditions which posed a potential Health and Safety risk for all residents in care.	8 9 10 11 12 13 14
Type B 08/25/2021 Section Cited CCR 87625(b)(3)	1 2 3 4 5 6 7	The licensee shall be responsible for the following: Ensuring that the facility remains free of odors from incontinence. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	POC cleared as evidenced by facility closure. The facility closed on 8/25/2021.
	8 9 10 11 12 13 14	Based on interviews the licensee did not maintain the facility free from odors of incontinence which posed a potential Health and Safety risk for all 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: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

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