374604267-9-14-2023-08-AS-SJAB-CVWSM5-20230922135923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604267
Report Date: 09/14/2023
Date Signed: 09/14/2023 10:36:47 AM

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
08/02/2023 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20230802134650

FACILITY NAME:	CLOISTERS OF THE VALLEY, LLC		FACILITY NUMBER:	374604267
ADMINISTRATOR:	GONZALEZ, JEFF		FACILITY TYPE:	740
ADDRESS:	4171 CAMINO DEL RIO SOUTH		TELEPHONE:	(619) 283-2226
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92108
CAPACITY:	70	CENSUS: 61	DATE:	09/14/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Disha Hall, Executive Director		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff did not communicate with resident's representative prior to changing primary care physician

INVESTIGATION FINDINGS:

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On 9/14/2023 at about 9:30 AM, Licensing Program Analyst (LPA), Daniel Pena, conducted an unannounced complaint visit to the facility. After introducing and identifying himself, LPA met with Executive Director, Disha Hall, and discussed the elements of the complaint and purpose of the visit.

During today's visit, LPA met with Director Hall to deliver investigative findings. On August 2, 2023, CCLD received a complaint alleging the facility did not communicate with Resident 1's (R1) representative prior to changing the R1's Primary Care Physician (PCP). It was also alleged; changes were made to R1's medications through a community based physician rather than consulting with R1's provider. The Department's investigation consisted of interviews with staff and outside sources as well as facility inspection and record reviews.

It is undisputed, facility staff consulted with a community based provider in reviewing R1’s behavioral changes and medications. Records and interviews revealed, however, that the facility explained to R1's responsible

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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-20230802134650

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: CLOISTERS OF THE VALLEY, LLC	FACILITY NUMBER: 374604267
	VISIT DATE: 09/14/2023

NARRATIVE

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person that the telephone number they provided for R1's PCP did not afford direct contact with the doctor. Interviews and record reviews indicate that the facility made efforts to contact R1's PCP unsuccessfully but the calls were directed to an appointment center.

Interviews also showed that the facility informed R1's representative that a direct line was required to contact R1's physician for urgent medication and care changes. On July 13, 2023, the facility ultimately obtained R1's physician's direct number and they are now able to contact the doctor to consult for changes to R1’s care and medications. LPA confirmed this with R1's PCP on 9/8/2023. When discussing this matter with the physician, the doctor agreed that there was an issue with communication, but it has now been resolved.

The Department has investigated the allegation that the facility did not communicate with a resident's representative prior to changing primary care physician. Evidence obtained during this investigation confirmed communication challenges occurred between the facility administration and R1’s medical provider. However, there is insufficient evidence to prove the facility did not make efforts to contact R1’s provider. Due to the lack of evidence, the Preponderance of Evidence standard was not met. Therefore, the allegation is Unsubstantiated.

An exit interview was conducted and a copy of the Licensee’s Rights (LIC 9058 3/22) along with a copy of this report was provided to Director, Hall.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC9099 (FAS) - (06/04)

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