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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604227
Report Date: 10/05/2023
Date Signed: 10/05/2023 01:56:52 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
08/30/2023 and conducted by Evaluator Nacole Patterson
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230830162510
FACILITY NAME:SUMMERFIELD OF ENCINITASFACILITY NUMBER:
374604227
ADMINISTRATOR:MYERS,HEATHERFACILITY TYPE:
740
ADDRESS:1350 S. EL CAMINO REALTELEPHONE:
(760) 479-1818
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:56CENSUS: 46DATE:
10/05/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Resident Services Director Richard MarionaTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Staff did not administer medication as prescribed.
Licensee did not maintain medication administration record.
INVESTIGATION FINDINGS:
1
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3
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7
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10
11
12
13
Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced facility visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Resident Services Director Richard Mariona.

On 8/30/2023 it was alleged that staff did not administer medication as prescribed, and Licensee did not maintain a medication administration record. The Department’s investigation consisted of unannounced facility visits, review of facility and outside source records, interviews with facility staff, residents, outside sources, and LPA direct observations.

Regarding the allegation, "Staff did not administer medication as prescribed", it was alleged that a resident's (R1) medications were not given on multiple occasions. Staff interview revealed that there have been no medication errors for R1.

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 08-AS-20230830162510
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: 10/05/2023
NARRATIVE
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(Continued from LIC9099)

All staff members interviewed consistently stated that R1 had a history of refusing medications and the medications were attempted to be given each time, according to the prescription. Staff interview revealed that staff were adhering to the regulation of a resident's personal right to refuse or accept medications, and that they could not force R1 to take them. Outside source interview revealed that the Licensee did not have a history of errors in the timing of medications, or attempts to provide them. Review of facility and outside source records did not provide evidence of a medication error during the timeframe in question. Records review confirmed that the medications in question were refused, not missed. R1 was not able to be interviewed due to refusal.

Regarding the allegation, "Licensee did not maintain medication administration record", it was alleged that a staff member (S1) documented R1's medication record incorrectly. Staff and outside source interviews were inconsistent, and revealed that no staff member observed if R1 ingested or did not ingest the medication in question. The Executive Director conducted an internal investigation regarding the matter and the findings were inconclusive. Outside source information regarding the incident was not able to be corroborated due to refusal of the alleged witness identities. Additional outside source interview revealed no knowledge of documentation errors by the Licensee. R1 was not able to be interviewed due to refusal. Records review showed that the Licensee contacted the Department regarding the accusation of a documentation error, and informed of a change in procedure and additional training as a precaution. It is unknown whether R1 ingested the medication, therefore it is not possible to determine if the medication record was in error.

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 Resident Services Director Richard Mariona, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
08/30/2023 and conducted by Evaluator Nacole Patterson
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230830162510

FACILITY NAME:SUMMERFIELD OF ENCINITASFACILITY NUMBER:
374604227
ADMINISTRATOR:MYERS,HEATHERFACILITY TYPE:
740
ADDRESS:1350 S. EL CAMINO REALTELEPHONE:
(760) 479-1818
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:56CENSUS: 46DATE:
10/05/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Resident Services Director Richard MarionaTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not provide Responsible Party access to records.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Resident Services Director Richard Mariona.

On 8/30/2023 it was alleged that the Licensee did not provide a Responsible Party access to records. CCLD’s investigation involved unannounced facility visits, review of facility records, interviews with facility staff, residents, and outside sources. Staff interview confirmed that the Licensee received two records requests by the Responsible Party during the timeframe in question. Staff interview revealed that the Responsible Party was provided the requested records the same day of the first request, which was corroborated by records review. Staff interview revealed that the second request was for a report from the pharmacy that did not exist, and also records and communication regarding a specific staff member.

(Continued on LIC9099-C)
Unfounded
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20230830162510
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: 10/05/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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24
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31
32
(Continued from LIC9099)

Outside source interview confirmed that the named pharmacy did not generate or provide the report in question, therefore it did not exist to be given. Regarding the records requested pertaining to a staff member, the Responsible Party did not have the authority to make the request or receive documents for staff personnel's private information.

Based on records review and interviews, the allegation that the Licensee did not provide Responsible Party access to records is UNFOUNDED, meaning it was false, could not have happened, and/or is without a reasonable basis. The allegation has therefore been dismissed. An exit interview was conducted with Resident Services Director Richard Mariona, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4