374604103-12-11-2023-08-AS-SJAB-CYW2J4-20231226162542

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604103
Report Date: 12/04/2023
Date Signed: 12/11/2023 09:24:41 AM

Unsubstantiated

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
08/06/2020 and conducted by Evaluator Alyssa Ramirez

COMPLAINT CONTROL NUMBER: 08-AS-20200806160345

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:	12/04/2023
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Report Mailed to Licensee		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility locks resident in room at night.
Facility not notifying responsible party of changes in resident's condition.
Facility did not provide appropriate nighttime supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alyssa Ramirez concluded investigation regarding the above prior complaint allegation. Since the facility closed on 08-25-2021 due to change in ownership, the allegation finding was delivered to licensee via USPS certified mail.

On August 6, 2020, Community Care Licensing (CCL) received a complaint alleging that the facility locks resident in room at night, facility did not notify responsible party of changes in resident’s condition (Scabies) and facility did not provide appropriate nighttime supervision.
During the investigation, the Department conducted interviews, requested facility records conducted a compliance history review of the facility.

[Continued on LIC 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alyssa Ramirez	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

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-20200806160345

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: 12/04/2023

NARRATIVE

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[Continued from LIC 9099]

During the investigation, the Department conducted interviews, requested facility records conducted a compliance history review of the facility.

According to interview with Executive Director (ED), facility staff reported they do not lock resident’s doors and clarified that all resident’s can open and/or lock their own doors. ED denied not providing appropriate nighttime supervision and stated that staff conduct checks on all residents every two (2) to three (3) hours. ED also revealed that responsible parties were notified of recent incidents that occurred at the facility and notifications were sent out when resident’s tested positive and were treated for Scabies. Review of compliance history for the facility revealed that there was an investigation surrounding Scabies at the facility the month prior to this allegation. Previous investigation concluded that the facility took all necessary steps in response to the outbreak, including notifying necessary parties. Licensing Program Analyst (LPA) Jennifer Lott requested records from facility by emailing Executive Director on 8/11/2020. LPA Lott did not receive response from Executive Director. LPA Ramirez was unable to collect facility records at the time of closure due to the facility being closed for over three (3) years.

Based upon the foregoing, there is insufficient evidence to corroborate allegations. The above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegation is not valid.

A copy of this report along with Licensee/Appeal Rights (LIC 9058) was mailed via USPS Certified Mail to the former licensee’s mailing address on file.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alyssa Ramirez	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC9099 (FAS) - (06/04)

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