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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604333
Report Date: 04/24/2023
Date Signed: 04/25/2023 01:27:31 PM

Substantiated


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
01/09/2023 and conducted by Evaluator Renita Hall
COMPLAINT CONTROL NUMBER: 08-AS-20230109135220
FACILITY NAME:BEYOND INTELLECTUAL ABILITIES, LLCFACILITY NUMBER:
374604333
ADMINISTRATOR:ACOSTA, CHRISTIANFACILITY TYPE:
735
ADDRESS:1762 PEMBER AVETELEPHONE:
(619) 519-2770
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:4CENSUS: 4DATE:
04/24/2023
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Margarita Ellis, CNA
Christian Acosta, Director		TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Medications not given as prescribed
Staff are dispensing medications without a written order.
Facility is not maintaining client records
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced complaint visit regarding the above-mentioned allegations. LPA was allowed entry by the CNA, Margarita Ellis. LPA identified herself and disclosed the purpose of the visit and shared findings of the complaint with the CNA and the Director Christian Acosta joined the visit a few minutes later.

The Department investigated the above listed complaint allegations. The investigation consisted of a tour of the facility, and records review pertinent to this investigation.

Continued on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023
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 4
Control Number 08-AS-20230109135220
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: BEYOND INTELLECTUAL ABILITIES, LLC
FACILITY NUMBER: 374604333
VISIT DATE: 04/24/2023
NARRATIVE
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On January 9, 2023, the Department received evidence from a third-party source which verified violations of Title 22 regulations. It was alleged that, medications not given as prescribed, staff were dispensing medications without a written order, and staff were not maintaining client records. The facility was notified about the third-party report on November 21, 2022, and corrective actions have been implemented for all three allegations. Based on the evidence obtained during the complaint investigation, the allegations were found to be SUBSTANTIATED, as there is a preponderance of evidence to prove the alleged violations occurred.

An exit interview was conducted; plans of correction were reviewed, a copy of this report along with Licensee Appeal Rights LIC 9058 (REV 3/22) were provided the Director and his signature confirms receipt of these documents.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20230109135220
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: BEYOND INTELLECTUAL ABILITIES, LLC
FACILITY NUMBER: 374604333
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2023
Section Cited
CCR
80075(b)(5)(B)
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80075(b)Clients shall be assisted as needed with..medications. (5) If the client's physician has stated in writing that the client is unable to determine his/her own….the licensee shall be permitted to assist... (B) Once ordered by the physician the medication is given according….This requirement was not met:
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Licensee and staff to be administered as prescribed by physican. Licensee will provide a Mediation Administration Training to all staff by 04/25/2023 (completed on 04/25/2023)
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Based on review of records the licensee did not insure 1 of 4 client in care received medications according to physician’s directions which posed a potential health and safety risk to clients in care.
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Type B
04/25/2023
Section Cited
CCR
80075(b)(5)(A)
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80075(b) Clients shall be assisted as needed with….medications(5) If the client's physician has stated in writing that the client is unable to determine his/her own….the licensee shall be permitted to assist the client...(A)There is written direction from a physician….This requirement was not met:
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Licensee will obtain curent Physician's Order indicating all prescribed and over-the-counter medications by 04/25/23 (completed on 04/25/23)
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Based on review of records the licensee did not insure 1 of 4 client in care received medications according to physician’s directions which posed a potential health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20230109135220
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: BEYOND INTELLECTUAL ABILITIES, LLC
FACILITY NUMBER: 374604333
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2023
Section Cited
CCR
80075(b)(5)(C)
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80075(b) Clients shall be assisted as needed with….medications (C) A record of each dose is maintained in the client's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the client's response. This requirement was not met
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 Licensee will provide a Mediation Administration Training to all staff by 04/25/2023 (completed on 04/25/23)
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Based on review of records the licensee did not insure 1 of 4 client in care received medications according to physician’s directions which posed a potential health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4