374604227-6-16-2023-08-AS-LTEZ-CT9VV7-20230629164552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604227
Report Date: 06/16/2023
Date Signed: 06/16/2023 05:05:40 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
03/27/2023 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230327152133

FACILITY NAME:	SUMMERFIELD OF ENCINITAS		FACILITY NUMBER:	374604227
ADMINISTRATOR:	MYERS,HEATHER		FACILITY TYPE:	740
ADDRESS:	1350 S. EL CAMINO REAL		TELEPHONE:	(760) 479-1818
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	56	CENSUS: 44	DATE:	06/16/2023
		UNANNOUNCED	TIME BEGAN:	02:49 PM
MET WITH:	Heather Myers, Executive Director		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not follow resident's care plan, resulting in a fall.
Resident was not provided a modified diet, as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Heather Myers, Executive Director.

On 3/27/23 it was alleged that staff did not follow a resident's care plan which resulted in a fall, and that a resident was not provided a modified diet, as prescribed. The Department’s investigation consisted of two unannounced facility tours, review of facility and outside source records, interviews with facility staff, residents, and outside sources, and LPA direct observations.

Regarding the allegation, "Staff did not follow resident's care plan, resulting in a fall", it was alleged that staff did not perform a 2-person assist for a resident during a transfer, which resulted in a fall in the shower. Staff interview revealed that all caregivers have been trained with 2-person assist transfer protocols for residents and are aware of each resident who requires them.
(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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-20230327152133

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SUMMERFIELD OF ENCINITAS	FACILITY NUMBER: 374604227
	VISIT DATE: 06/16/2023

NARRATIVE

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(Continued from LIC9099)
Staff interviews revealed that the 2-person transfer protocol was followed for the resident in question during the timeframe of the complaint, and staff consistently identified that the resident in question requires a 2-person assist for transferring. Interviewed outside sources did not have concerns or observe incorrect transfers by staff for the resident in question. Records review revealed online training for caregiving staff on how to safely transfer residents. Records reviewed showed that the resident in question requires a 2-person assist per the Needs and Services Plan. On 2 unannounced facility visits LPA directly observed staff members performing 2-person transfers for residents. LPA also observed staff requesting assistance for 2-person transfers over the walkie talkies. The interview with the resident in question was unsuccessful due to their cognitive state.

Regarding the allegation, "Resident was not provided a modified diet, as prescribed", it was alleged that a resident was fed restricted food items according to their dietary needs. Staff interview revealed that the facility has a protocol for residents who have dietary restrictions, and caregivers and kitchen staff are instructed of the protocol during onboarding. All interviewed staff confirmed knowledge of the same procedure for prescribed modified diets as well as the residents who have restricted diets. Staff interview revealed that each time a new order is made by a resident's doctor regarding a restricted diet, staff members on all shifts are notified and all documentation is updated around the facility. Records review revealed that dietary restriction lists are placed in "Resident Special Diet" binders in the kitchen, on the inside door of the kitchen, and in the resident's file. Records review showed that residents with dietary restrictions have a sticker placed on the plate cover with their name on it to ensure their specific meal is served to them. Interviewed outside sources did not observe or have concerns that the resident in question was being served restricted food items. During an unannounced facility visit LPA directly observed the procedures for food restrictions including the "Resident Special Diet" binder, posted lists of residents with food restrictions, and the plate cover stickers with residents' names who have restricted diets. Resident interviews did not give evidence to the allegation that restricted food items had been served to residents with modified diets. The interview with the resident in question was unsuccessful due to their cognitive state.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Janelle Harris, Business Office Manager, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

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