374604323-1-26-2023-08-AS-SJAB-CNL2ZJ-20230130165026

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604323
Report Date: 01/26/2023
Date Signed: 01/26/2023 02:12:41 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
01/20/2023 and conducted by Evaluator Elizabeth Hamilton

COMPLAINT CONTROL NUMBER: 08-AS-20230120103816

FACILITY NAME:	SILVERGATE RANCHO BERNARDO		FACILITY NUMBER:	374604323
ADMINISTRATOR:	BRAKEVILLE, SONDRA		FACILITY TYPE:	740
ADDRESS:	16061 AVENIDA VENUSTO		TELEPHONE:	(858) 451-1100
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92128
CAPACITY:	285	CENSUS: 178	DATE:	01/26/2023
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Executive Director, Sonder Brakeville		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff did not follow infection control plan

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced complaint investigation visit at the facility for the above allegation. LPA gained access to the facility and met with Executive Director, Sondra Brakeville. LPA explained the purpose of the visit and the elements of the complaint.

The Department’s investigation consisted of records review, interviews with staff and outside sources.

On January 20, 2023, it was alleged that staff did not follow infection control plan. More specifically, in reference to the COVID-19 protocols in the memory care unit by COVID-19 positive residents not quarantining. Interviews with staff corroborated memory care residents were quarantined by sections when a COVID-19 resident was identified as positive and wandering behaviors were known. The memory care building has two levels with two sections on each floor that are each divided by a hallway. LPA observations confirmed each memory care section on each level was able to quarantine by closing the hallway door to each section.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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-20230120103816

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: SILVERGATE RANCHO BERNARDO	FACILITY NUMBER: 374604323
	VISIT DATE: 01/26/2023

NARRATIVE

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LPA further observed PPE carts available to be used outside of the COVID positive areas. Community Care Licensing Division (CCLD) has been in contact with the facility regarding the COVID-19 positive residents. Records reviewed confirmed staff trainings on COVID-19 protocols. Records further confirmed the facility was in contact with County Public Health and the facility’s COVID-19 infection control plan was followed when the facility had COVID-19 positive residents.

Based on the evidence obtained from the complaint investigation, the allegation that staff did not follow infection control plan is found to be UNSUBSTANTIATED, meaning that there is not a preponderance of evidence to find that allegation true.

An exit interview was conducted with Executive Director, Sondra Brakeville and a copy of this report and Licensee's Rights (9058 01/16) were provided.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC9099 (FAS) - (06/04)

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