374604171-6-27-2023-08-AS-SJAB-CT7TMK-20230627145115

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604171
Report Date: 06/26/2023
Date Signed: 06/27/2023 11:29:58 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
06/14/2023 and conducted by Evaluator Iby Strong

COMPLAINT CONTROL NUMBER: 08-AS-20230614101535

FACILITY NAME:	LO-HAR SENIOR LIVING		FACILITY NUMBER:	374604171
ADMINISTRATOR:	DUCHARME-FRANKLIN, KANDY		FACILITY TYPE:	740
ADDRESS:	768 DOROTHY ST		TELEPHONE:	(619) 444-8270
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY:	68	CENSUS: 57	DATE:	06/26/2023
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Administrator Rhon Hipolito		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Neglect resulted in resident elopement

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings in the above complaint allegation. LPA identified herself and discussed the purpose of the visit with Administrator Rhon Hipolito.

On June 14, 2023, Community Care Licensing (CCL) received a complaint alleging Resident 1 (R1) eloped from the facility due to neglect.

During the investigation, LPA Strong conducted interviews, and reviewed facility records. According to allegations, R1 has continuously eloped from the facility within the last six months. According to R1’s Physician Report, R1 is diagnosed with a major neurocognitive disorder, is not allowed to leave facility unassisted and has wandering behavior. Additionally, R1 Service Plan, R1 does not require incontinence care but does require safety checks. According to staff interviews, R1 has not left facility five times within the last six months.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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-20230614101535

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: LO-HAR SENIOR LIVING	FACILITY NUMBER: 374604171
	VISIT DATE: 06/26/2023

NARRATIVE

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Records collected revealed that R1 left facility unassisted on May 31, 2023 and this event was reported to Community Care Licensing, responsible party and resident’s primary care physician. Interview with caregiver present on the date of incident revealed that R1 was last seen at 3:40pm and was returned to the facility by 4:00pm. Review of absentee notification plan revealed that facility followed established protocol.

Based on LPA's interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation are unsubstantiated. An exit interview was conducted with Administrator Rhon Hipolito, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

LIC9099 (FAS) - (06/04)

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