374604171-6-27-2023-08-AS-SJAB-CT7SW6-20230627141349

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604171
Report Date: 06/26/2023
Date Signed: 06/27/2023 07:54:43 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
05/12/2023 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230512154008

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 injury

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 May 12, 2023, Community Care Licensing (CCL) received a complaint alleging Resident 1 (R1) sustained an injury due to neglect.

During the investigation, LPA Strong conducted interviews, and reviewed facility records. According to allegations, on May 11, 2023, R1 was observed to have a large new bruise to the left eye. According to R1’s Physician Report signed August 4, 2022, R1 is diagnosed with a major neurocognitive disorder, does not require continuous bed care and is able to communicate needs. Additionally, R1 Service Plan signed March 15, 2023, R1 requires assistance with transfers and is non-ambulatory. Interview with outside source revealed that a large healing bruise was seen on R1’s left eye on May 8, 2023.

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-20230512154008

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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Interview with staff revealed that R1 could not express how the bruise occurred. Interview also revealed that on May 6, 2023, Caregiver 1 (C1) observed R1 soaked with water, R1 then stated to C1 that Resident 2 (R2) wet R1, C1 states that there may have been an additional altercation between the two residents, but this was not witnessed. Later that day C1 observed the bruise to R1’s left eye. Interview with Wellness Coordinator revealed that internal investigation revealed no information to identify the cause of the bruise.

Based on LPA's interviews, and record reviews there is not a preponderance of evidence to prove alleged violations 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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