374604224-3-12-2024-08-AS-IESA-D3W8EN-20240331222724

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604224
Report Date: 03/12/2024
Date Signed: 03/12/2024 10:37:32 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
03/23/2023 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20230323154855

FACILITY NAME:	LA COSTA COASTAL CARE		FACILITY NUMBER:	374604224
ADMINISTRATOR:	SUBOTIC, LUKA		FACILITY TYPE:	740
ADDRESS:	3207 LA COSTA AVENUE		TELEPHONE:	(760) 452-6264
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92009
CAPACITY:	6	CENSUS: 5	DATE:	03/12/2024
		UNANNOUNCED	TIME BEGAN:	10:09 AM
MET WITH:	Ida Mendoza, Caregiver		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Neglect/ Lack of supervision resulted is resident being sexually abused.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to deliver findings for a complaint investigation regarding the above-mentioned allegation. LPA identified herself and met with Ida Mendoza, Caregiver, to discuss the purpose of the visit and elements of the complaint.

The Department's investigation included interviews and a review of pertinent records. It was alleged that Neglect/ Lack of supervision resulted in resident being sexually abused. Resident 1 (R1) was diagnosed with Malignant neoplasm of central portion of the left breast. The cancer had also metastasized to the bone and their right lung. R1 was admitted from their residence to La Costa Coastal on 02/24/2023. Hospice of the North Coast was being provided to R1 prior to being admitted to La Costa Coastal. On or about 03/22/23 – 03/23/23 R1 reported to their daughter that they had been sexually assaulted by Staff 1 (S1) between late evening-early morning between 03/22/23 and 03/23/23. R1s health had declined from the cancer, and they were requiring assistance transferring from their bed to the bedside commode. According to interviews Staff 1 (S1) was the overnight caregiver assigned to assist R1 during their shifts. After R1 disclosed their abuse to their Responsible Party (RP) they notified the hospice nurse about the allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

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-20230323154855

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: LA COSTA COASTAL CARE	FACILITY NUMBER: 374604224
	VISIT DATE: 03/12/2024

NARRATIVE

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Interviews revealed R1 was medically evaluated by a hospice nurse who found no injuries or signs of abuse. Interviews revealed the hospice nurse and social worker evaluated R1 and asked them questions about the abuse. Interviews revealed that R1 was unable to provide clear statements. Interviews with outside sources revealed R1 was confused and unable to provide any details regarding the incident. Interviews with S1 revealed them denying the allegation of engaging in sexual misconduct with R1. On 04/09/23, interviews with R1s RP revealed they do not believe S1 was inappropriate with R1. Interviews with RP revealed that R1s health declined rapidly and R1 was making delusional statements prior to passing away. There is not enough information to support the allegation of Neglect/ Lack of supervision resulted in resident being sexually abused. Therefore, the allegation is unsubstantiated. This finding means although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Ida Mendoza, Caregiver. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided and their signature on this report confirms receipt of the Licensee Rights.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC9099 (FAS) - (06/04)

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