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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604336
Report Date: 08/16/2022
Date Signed: 08/16/2022 02:02:54 PM

Substantiated


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
08/09/2022 and conducted by Evaluator Amy Domingo
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20220809090925
FACILITY NAME:COMPASSIONATE CARE FOR SENIORS 1FACILITY NUMBER:
374604336
ADMINISTRATOR:BACINSKI, MAJAFACILITY TYPE:
740
ADDRESS:8100 BINNEY PL.TELEPHONE:
(619) 303-0670
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:6CENSUS: 6DATE:
08/16/2022
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Maja Bacinski, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff are not adhering to Covid-19 infection Control Guidance

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Domingo and Interim Assistant Program Administrator (IAPA) Icela Estrada conducted an unannounced visit to open a complaint investigation regarding the above-mentioned allegation. LPA and IAPA identified themselves, discussed the purpose of the visit, and met with Administrator, Maja Bacinski.

The Department’s investigation consisted of observations and an interview with the administrator. It was alleged that facility staff are not adhering to COVID-19 Infection Control Guidance. During today’s complaint investigation visit, LPA and IAPA observed three staff, to include Administrator, Maja Bacinski not wearing a face mask. Interview with Administrator Bacinski revealed that all staff and residents have been vaccinated and masks are not worn because they hinder communication with residents. Residents have a difficulty understanding staff. Administrator did acknowledge that masks must be worn by staff while in the facility. During the visit, all staff put surgical masks on.

Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
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-20220809090925
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: COMPASSIONATE CARE FOR SENIORS 1
FACILITY NUMBER: 374604336
VISIT DATE: 08/16/2022
NARRATIVE
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Based on observations and interview, the above allegation is determined to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. A deficiency is cited per Title 22 of the California Code of Regulations and is listed on form LIC 9099-D.

An exit interview was conducted with Administrator Bacinski which included developing a plan of correction for the deficiency. A copy of this report, LIC 9099, LIC 9099-D, LIC 811 Confidential Names List, and the Licensee/Appeal Rights (LIC 9058 01/16) were provided at the conclusion of the visit. The administrator’s signature on the forms confirms receipt of these documents.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20220809090925
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: COMPASSIONATE CARE FOR SENIORS 1
FACILITY NUMBER: 374604336
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2022
Section Cited
CCR
87468.1(a)(2)
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Personal Rights of Residents in All Facilities To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on observations and interview, the licensee did not accord healthful accommodations in 6 of 6 persons in care
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The licensee agrees to having the County of San Diego HAI team come out to provide an assessment and PPE training to staff. LIcensee will provide LPA with a sign in sheet of staff that attended the PPE training.
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in which posed a potiential health and personal rights risk to persons 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: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4