374604258-2-27-2024-18-AS-RSTS-D2WKLL-20240229070004

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604258
Report Date: 10/10/2023
Date Signed: 02/27/2024 02:17:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/05/2023 and conducted by Evaluator Sara Martinez

COMPLAINT CONTROL NUMBER: 18-AS-20230905151012

FACILITY NAME:	ALDINE RESIDENTIAL CARE		FACILITY NUMBER:	374604258
ADMINISTRATOR:	ADAYA, GERALDINE		FACILITY TYPE:	740
ADDRESS:	794 MARSOPA DR		TELEPHONE:	(858) 216-5613
CITY:	VISTA	STATE: CA	ZIP CODE:	92081
CAPACITY:	6	CENSUS: 5	DATE:	10/10/2023
		UNANNOUNCED	TIME BEGAN:	10:06 AM
MET WITH:	Ariel Remot - Caregiver		TIME COMPLETED:	11:29 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not assisting resident in care with eating as necessary.
Staff are not seeking medical attention as necessary for resident in care.
Facility is odiferous.
Facility is dirty.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to the facility to conclude an investigation regarding the allegations listed above. LPA was granted entry and met with XXXX XXXXX who was informed of the purpose for this visit.

Regarding the allegation "Staff are not assisting resident in care with eating as necessary”, it was reported Resident One (R1) is losing weight due to staff not assisting R1 with eating. Record Review of R1’s physician report states R1 is not able to feed themselves and requires staff assistance. LPA conducted interviews with staff, residents, and R1 hospice Vitas Healthcare that does not corroborate with this allegation. Resident Two (R2) stated staff are always attentive towards the residents and even though R1 cannot eat a lot of food, facility staff are always serving R1 food. During the initial visit LPA observed Staff One (S1) assisting R1 with eating soup. Therefore, based on interviews, observation, and record review this allegation is unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

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 2

Control Number 18-AS-20230905151012

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ALDINE RESIDENTIAL CARE	FACILITY NUMBER: 374604258
	VISIT DATE: 10/10/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation “Staff are not seeking medical attention as necessary for resident in care” it was reported facility staff do not contact R1’s hospice agency for assistance regarding R1’s declining condition. Interviews with Hospice social worker and manager revealed the facility is taking care of R1 and meeting R1’s assisted daily living (ADL) needs. R1’s power of attorney (POA) is always receiving phone calls from either the facility staff or hospice agency to update POA (Power of Attorney) on R1’s condition. POA stated staff had contacted POA late at night around 11pm to update POA of R1 having a change in condition and R1’s hospice agency was contacted to have a nurse go to the facility to check on R1’s condition. Record review for Vitas Hospice Visit Description Log shows facility staff had called R1’s hospice service for an unscheduled visit due to a change in R1’s condition on 09/02/2023 and 09/09/2023. Therefore, based on interviews and record review the allegation “Staff are not seeking medical attention as necessary for resident in care” has been deemed unsubstantiated at this time.

Regarding the allegation “Facility is odiferous ”, it was reported two separate bedrooms, R1’s bedroom and R2’s bedroom, have a rancid smell of urine the facility is not taking care of. LPA’s visit on 09/14/2023 and 10/10/2023 revealed no strong odors of urine present in R1’s room, R2’s room, or throughout the facility. Interview with a social worker from R1’s hospice agency revealed they have never received any reports from their hospice agency staff indicating any concerns regarding the facility having a rancid odor. Interview with R2 revealed they have not observed any urine or rancid odors in their room or throughout the facility. Therefore, based on interviews and observations, the allegation “Facility is odiferous” has been deemed unsubstantiated at this time.

Regarding the allegation “Facility is dirty”, it was reported the bathrooms are dirty and the garage is cluttered with storage, dirty clothes, and cockroaches LPA’s visit on 09/14/2023 and 10/10/2023 revealed the rooms and bathrooms were clean, safe, and in sanitary condition. Staff stated they clean the bathrooms after each residents use, tidy up resident bedrooms, and clean the facility daily. LPA observed the garage and did not observe any hazardous clutter or cockroaches. Interviews with R1’s POA (Power of Attorney), residents, and R1’s hospice agency revealed no concerns that would prove that the facility is dirty. R2 interview revealed the facility is always clean and staff always help keep R1’s room clean. Therefore based on observation and interviews the allegation “Facility is dirty” has been deemed unsubstantiated at this time.
A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation occurred.
An exit interview was conducted; this report was reviewed with XXXX XXXXX and a copy was provided, along with the LIC 811.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2