374604328-10-13-2022-08-AS-LTEZ-CKN2R5-20221028173658

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604328
Report Date: 10/13/2022
Date Signed: 10/13/2022 04:00:29 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
04/04/2022 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20220404105920

FACILITY NAME:	UC CARE SENIOR LIVING I		FACILITY NUMBER:	374604328
ADMINISTRATOR:	KELLY, FLORA		FACILITY TYPE:	740
ADDRESS:	3664 GOVERNOR DR		TELEPHONE:	(858) 750-3455
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92122
CAPACITY:	6	CENSUS: 6	DATE:	10/13/2022
		UNANNOUNCED	TIME BEGAN:	03:40 PM
MET WITH:	Caregiver, Beatrice jimenez		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Facility restrained resident resulting in bruising
Facility did not meet the resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabel Martinez, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. The LPA was greeted by Beatrice Jimenez, identified himself, and disclosed the purpose of the visit. The Department’s investigation consisted of review of records, and interviews with internal and external sources.

It was alleged the Facility staff restrained a resident resulting in bruising. Interviews with internal sources revealed bruises have not been witnessed on any of the residents at the facility. Some of the residents may suffer from dementia, and bruises can form from bumping into different items. There were no concerns of residents suffering from unexplained bruises, but interviews with internal sources yielded conflicting statements regarding restraints. On multiple visits conducted to the facility by external sources, and the Department, there were no visible bruises on the residents, nor immediate concerns to the health, safety, and personal rights of the residents in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

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-20220404105920

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: UC CARE SENIOR LIVING I	FACILITY NUMBER: 374604328
	VISIT DATE: 10/13/2022

NARRATIVE

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It was alleged the Facility staff did not meet the resident's needs. An outside source reported a resident was often denied water during the night shift. Interviews with internal sources revealed residents had access to water, could request water during the night shift, and often, residents already had a water container prepared in advance. Interviews with outside sources did not corroborate residents were not being provided water at night and did not reveal any concerning circumstances. During visits to the facility, the Department corroborated multiple residents had water containers in their rooms readily available.

Based on the evidence obtained through observations, review of records, and interviews with internal and external sources, there was not a preponderance of evidence to prove the violations occurred, therefore, the allegations are unsubstantiated.

An exit interview was conducted with Caregiver, Beatrice Jimenez. A copy of this report and Licensee's Rights (LIC 9058 01/16) were provided to Administrator, Flora Kelly, via electronic mail. An electronic mail read receipt confirms these documents were received by the administrator.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

LIC9099 (FAS) - (06/04)

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