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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604227
Report Date: 05/12/2022
Date Signed: 05/31/2022 10:22:45 AM

Substantiated


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
06/11/2020 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20200611160446
FACILITY NAME:SOMERFORD PLACE-ENCINITASFACILITY NUMBER:
374604227
ADMINISTRATOR:Y'LONN, HUDSONFACILITY TYPE:
740
ADDRESS:1350 S. EL CAMINO REALTELEPHONE:
(617) 796-8350
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:56CENSUS: 29DATE:
05/12/2022
UNANNOUNCEDTIME BEGAN:
01:03 PM
MET WITH:Executive Director Heather MyersTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff failed to provide resident's records to authorized representative.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Correia conducted an unannounced visit to deliver investigative findings on the above listed complaint allegation. LPA Correia met with Executive Director (ED) Myers to whom was explained the purpose for the visit.

The Department’s investigation consisted of a resident record review and staff and outside source interviews.

It was alleged facility staff failed to produce Resident’s (R1) (See Confidential Names List LIC 811) records when requested by R1’s authorized representative. A record review revealed on June 5, 2020 a records request was submitted to the facility for R1. An interview with facility staff revealed R1’s facility file was sent to Administrative staff to fulfill the record request. An additional interview with the facility Administrative staff corroborated receiving the file containing R1’s records and the record request. The interview also confirmed the record request was never processed and provided to the requesting party.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
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 3
Control Number 08-AS-20200611160446
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: SOMERFORD PLACE-ENCINITAS
FACILITY NUMBER: 374604227
VISIT DATE: 05/12/2022
NARRATIVE
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Based on interviews conducted and a record review the above allegation is determined to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. The deficiency has been cited per Title 22 Regulations and listed on the following 9099 D page.

An exit interview was conducted with ED Myers and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to ED Myers. Signature on this report confirms the documents were received.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20200611160446
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: SOMERFORD PLACE-ENCINITAS
FACILITY NUMBER: 374604227
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2022
Section Cited
CCR
87506(C)(1)
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Resident Records(c) All information... regarding residents shall be confidential. (1) The licensee shall be responsible for... safeguarding the confidentiality of their contents. The licensee...shall make available...information...upon ...resident's written consent or...representative.

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ED Myers will provide in-service training to administrative staff regarding the topic of records management, and resident or authorized representatives rights to obtain records in a timely fashion. ED Myers will provide complete proof of completion by POC due date.
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Based on staff and outside source and staff interviews and a resident record review the Licensee did not provide resident records requested by an authorized party for 1 out of 37 residents in care. This poses a potential risk to residents in care.

ED Myers will provide in-service training to administrative staff regarding the topic of records management, and resident or authorized representatives rights to obtain records in a timely fashion. ED Myers will provide complete proof of completion by POC due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3