374604103-6-17-2024-08-AS-IESA-D6RMMM-20240701094411

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604103
Report Date: 06/17/2024
Date Signed: 06/17/2024 09:02:05 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
10/16/2020 and conducted by Evaluator Becky Kennedy

COMPLAINT CONTROL NUMBER: 08-AS-20201016094026

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:	06/17/2024
		UNANNOUNCED	TIME BEGAN:	08:53 AM
MET WITH:			TIME COMPLETED:	09:09 AM

ALLEGATION(S):

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Staff did not inform resident's authorized representative that resident had scabies

INVESTIGATION FINDINGS:

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It was alleged that facility staff did not inform resident's authorized representative that resident had scabies.
Licensing Program Analyst (LPA) Becky Kennedy concluded the investigations into the above allegations. The investigation began on 10/22/2020.
The investigation into the allegation included a facility visit, interviews, and a review of records. The investigation revealed that Resident 1 (R1) resided at the facility when there was a scabies outbreak. R1’s authorized representative was informed by facility staff that the facility had an outbreak of scabies and that R1 was not diagnosed with scabies, however, with the agreement of R1’s authorized representative would be treated for scabies prophylactically.
The records do not reflect that R1 received a medical diagnosis confirming that they had scabies, however R1’s representative reports that R1 had itching and a rash, while the facility had several residents with scabies.

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: 06/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024

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-20201016094026

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: 06/17/2024

NARRATIVE

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R1 was treated subsequently with prescriptions for scabies. R1’s representative continued to observe significant itching and was dissatisfied with R1’s treatment for scabies. Throughout this time there was communication between R1’s representative and the facility staff.

Although R1 may have had scabies, there is no evidence to support the allegation that R1 was diagnosed by a medical provider as having scabies and that the facility staff did not inform R1’s authorized representative. This allegation is unsubstantiated meaning there isn’t enough evidence to prove a violation occurred.

This report, along with Licensee Rights were mailed to the licensee via USPS mail to the last known 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: 06/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024

LIC9099 (FAS) - (06/04)

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