374604177-11-17-2022-08-AS-SJAB-CLP2RW-20221130163813

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604177
Report Date: 11/17/2022
Date Signed: 11/17/2022 11:11:58 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/24/2021 and conducted by Evaluator Elizabeth Hamilton

COMPLAINT CONTROL NUMBER: 08-AS-20210924080310

FACILITY NAME:	ATRIA BONITA		FACILITY NUMBER:	374604177
ADMINISTRATOR:	WILLIAMS, REBECCA		FACILITY TYPE:	740
ADDRESS:	3434 BONITA ROAD		TELEPHONE:	(619) 476-9444
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	145	CENSUS: 102	DATE:	11/17/2022
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Executive Director, Emily Delabarre and Regional Director of Operations, Kathleen Calobeer		TIME COMPLETED:	10:55 AM

ALLEGATION(S):

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Staff did not follow resident's care plan.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced complaint investigation visit at the facility. LPA gained access to the facility, met with Executive Director, Emily Delabarre and Regional Director of Operations, Kathleen Calobeer and explained the purpose of the visit which was to deliver findings for the above allegations

The Department’s investigation consisted of record reviews, interviews with staff and outside sources.

On September 24, 2021, it was alleged that on September 20, 2021, staff did not follow resident 1’s (R1) care plan. Around 5:00 am, R1 who resided in memory care, was found on their bedroom floor sometime between 4:00 and 5:00 am. Interview with staff 1 (S1) confirmed they observed R1 in bed at 4:00 am prior to being found on the floor. R1 was assessed with no injuries. Interview with Resident Services Director (RSD) revealed there was a “verbal facility” policy that residents in memory care were to have status checks every two hours.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

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-20210924080310

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ATRIA BONITA	FACILITY NUMBER: 374604177
	VISIT DATE: 11/17/2022

NARRATIVE

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Interview with S1 confirmed that status checks for residents in memory care varied depending on the care needs. On the night in question, staff statements maintained R1 was checked every two hours prior to being observed on the floor at 5:00 am. Records reviewed including R1’s care plan revealed R1 was a fall risk and status checks were one time per shift and six times per day. Interviews with outside sources did not have concerns during the time in question. There was no additional evidence provided, or records found during this investigation to support this allegation.

The Department has investigated the allegation listed above. Based on evidence obtained, including interviews and records reviewed, the above allegation is determined to be unsubstantiated as the Department could not meet the preponderance of the evidence standard. An exit interview was conducted with Executive Director, Emily Delabarre and Regional Director of Operations, Kathleen Calobeer and a copy of this report and Licensee/Appeals Rights (LIC 9058 01/16) was provided.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC9099 (FAS) - (06/04)

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