374604227-6-22-2023-08-AS-SJAB-CT7KUZ-20230627081333

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604227
Report Date: 06/22/2023
Date Signed: 06/22/2023 11:28:42 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
12/16/2021 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20211216095955

FACILITY NAME:	SOMERFORD PLACE-ENCINITAS		FACILITY NUMBER:	374604227
ADMINISTRATOR:	ROLFE, BROOKE		FACILITY TYPE:	740
ADDRESS:	1350 S. EL CAMINO REAL		TELEPHONE:	(760) 479-1818
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	56	CENSUS: 45	DATE:	06/22/2023
		UNANNOUNCED	TIME BEGAN:	10:59 AM
MET WITH:	Janelle Harris		TIME COMPLETED:	11:39 AM

ALLEGATION(S):

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Resident was allowed to wander outside of designated wing

Facility failed to follow reporting requirements

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Business Office Manager Janelle Harris and we discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of LPA observation, records review, interviews with facility staff and outside agency.

It was reported to CCL that on December 12, 2021 Resident 1 (R1) (an LIC 811 Confidential Names List was provided to the facility representative to identify the resident) was allowed to wander outside of their designated wing. It was also alleged that the facility failed to report this incident to CCL. LPA visit to the facility on December 21, 2021 revealed the entire facility is memory care. LPA toured the facility and witnessed residents moving throughout the circular shaped building which included an indoor patio area. The building layout allows all of the residents to move throughout the entire facility in a safe and secure manner.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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-20211216095955

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: SOMERFORD PLACE-ENCINITAS	FACILITY NUMBER: 374604227
	VISIT DATE: 06/22/2023

NARRATIVE

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LPA review of records revealed an incident report involving R1 was submitted to CCL on December 14, 2021. The incident report indicated in detail what occurred on December 12, 2021 at the facility and the actions that were taken.

Interview with Executive Director (ED) revealed the community is separated into four neighborhoods within one building. There are two open courtyards in between each neighborhood. ED stated that ambulatory residents are able to walk through out the community and they are returned to their respective community during meal time. ED also added that resident's are also able to ambulate to and from activities. All residents that need assistance are escorted.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid.

An exit interview was conducted with Janelle Harris. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Janelle Harris whose signature below verifies receipt of these rights.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC9099 (FAS) - (06/04)

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