374604281-2-10-2023-08-AS-DPOL-CPH2CX-20230228161729

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604281
Report Date: 02/10/2023
Date Signed: 02/10/2023 02:48:22 PM

Unsubstantiated

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
01/06/2023 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20230106151607

FACILITY NAME:	OAKMONT OF PACIFIC BEACH		FACILITY NUMBER:	374604281
ADMINISTRATOR:	CAROLINE SENTENO		FACILITY TYPE:	740
ADDRESS:	955 GRAND AVE		TELEPHONE:	(858) 373-9300
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92109
CAPACITY:	92	CENSUS: 76	DATE:	02/10/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Executive Director, Caroline Senteno		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee did not treat insect infestation
Staff yelled at resident

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Executive Director, Caroline Senteno.

The Department investigated the above listed complaint allegations. The investigation consisted of a tour of the facility, multiple interviews with staff and outside sources, and records review, including relevant evidence pertinent to this investigation such as Pest Control maintenance contract agreements and Inspection Reports.

On January 6, 2023, Community Care Licensing (CCL) received a complaint alleging that facility staff did not treat insect infestation. It was alleged that on December 16, 2022, a cockroach was observed in Resident (R1's) room, [an LIC 811 Confidential Names List was provided to staff to identify the Resident(Continue on LIC9099C)].

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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 3

Control Number 08-AS-20230106151607

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: OAKMONT OF PACIFIC BEACH	FACILITY NUMBER: 374604281
	VISIT DATE: 02/10/2023

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

(Continue from LIC9099)

On January 13, 2023, the Department conducted a tour of the facility that included a full inspection of three residents’ rooms including R1’s room, which revealed no signs of insects, including cockroaches. During the inspection the rooms were observed to be clean and in good repair and there was no observable evidence of any type of insects.

In addition, records reviews confirmed that the facility had an active contract agreement with a certified pest control company from 11/16/2017 to 12/31/2022. Due to a clerical error, there was a lapse in service for the month of January 2023; however, the contract was reinstated on February 1, 2023. Review of the terms of the pest control contract indicated that facility inspections were performed every 30 days and treatments were applied when required. The last service performed by the pest control company was on December 6, 2022. Per staff interviews and records review, three separate inspections were conducted by facility maintenance and treatments were applied when appropriate as well as bug traps were placed in R1’s room. R1’s room was inspected on December 17, December 18, and December 19, 2022 with no findings of any insects. Per interviews with outside sources, it was confirmed that there had not been any pest infestations recently other than occasional ant problems which were treated accordingly.

Staff interviews were consistent which indicated that they had not observed any insects in the residents’ rooms. However, a staff member stated that R1 reported on one occasion seeing cockroaches in their room. During the investigation, it was confirmed that this incident was promptly reported to maintenance staff as required and staff took immediate action to treat possible insect infestation. Based on observations, interviews with key staff and outside sources, and review of pertinent pest control inspection reports, there was insufficient evidence found to support the allegation that facility staff did not treat insect infestation.

It was also alleged that staff yelled at R1. Specifically, it was alleged that R1 was yelled at by staff during the night shift when R1 called for assistance using their pendant. The dates and/or times of when this behavior allegedly occurred or examples of when staff yelled at R1 was not identified. LPA was unable to obtain credible information from resident interviews corroborating this allegation.

(Continue on LIC9099C)

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 08-AS-20230106151607

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: OAKMONT OF PACIFIC BEACH	FACILITY NUMBER: 374604281
	VISIT DATE: 02/10/2023

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

(Continue from LIC9099C)

Review of records indicated that R1 had been living at a different facility for several years and was recently placed in this facility. Interviews with staff and outside sources indicated that R1 was having a challenging time adjusting to new surroundings which was causing agitation and trouble sleeping. R1’s care plan was updated following orders from R1’s physician to discontinue a medication that was causing R1 to be agitated and was causing hallucinations. According to staff interviews, R1’s state of mind improved after medication was discontinued. Interview with Administrator confirmed no staff member reporting any yelling observed by any staff members. Interviews with outside sources indicated that they had not witnessed or had knowledge of staff yelling at R1. Review of training records indicated that staff completed all required training in Elder Abuse and Mandated Reporter requirements.

Due to a lack of evidence, both allegations are deemed to be unsubstantiated. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence that the alleged violations occurred.

An exit interview was conducted with Executive Director, Caroline Senteno to whom a copy of this report, LIC 811 and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3