374604347-6-28-2022-08-AS-DPOL-CGSPNP-20220729112818

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604347
Report Date: 06/28/2022
Date Signed: 06/28/2022 12:37:28 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
06/14/2022 and conducted by Evaluator Elizabeth Hamilton

COMPLAINT CONTROL NUMBER: 08-AS-20220614141111

FACILITY NAME:	SUNSET COAST ASSISTED LIVING		FACILITY NUMBER:	374604347
ADMINISTRATOR:	TAPIA, PATRICIA		FACILITY TYPE:	740
ADDRESS:	808 THERMAL AVE		TELEPHONE:	(619) 882-5003
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92154
CAPACITY:	6	CENSUS: 3	DATE:	06/28/2022
		UNANNOUNCED	TIME BEGAN:	11:12 AM
MET WITH:	Licensee, Patricia Tapia		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Licensee did not provide responsible party with a refund

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced complaint investigation visit at the facility. LPA was greeted at the front entrance by Caregiver, Maria Labra and granted entry after identifying herself. LPA Hamilton explained the purpose of the visit was to deliver findings for the above allegation to Licensee, Patricia Tapia.

On June 14, 2022, it was alleged that Licensee did not provide responsible party with a refund after the death of a resident. Interviews with staff and outside sources revealed Resident 1’s (R1 – See LIC 809 Confidential Names List) Responsible Party (RP) paid in advance for services for May 2022 April 30, 2022. Records reviewed confirmed the May 2022 payment in the amount of $5,000.00. R1 passed away under hospice care on May 19th 2022.

Substantiated

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: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

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-20220614141111

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: SUNSET COAST ASSISTED LIVING	FACILITY NUMBER: 374604347
	VISIT DATE: 06/28/2022

NARRATIVE

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Interviews with staff and outside sources revealed that after R1 passed away on May 19, 2022 at the facility, all their personal belongings were removed the same day by RP. The items that remained in R1’s room at the facility included; a wheelchair, shower chair, walker, hospital bed and oxygen tank, all supplied by a hospice agency as part of the agreed-upon hospice plan of care. The hospice agency that was under contract with R1 at the time of their death removed all items except the hospital bed and oxygen tank the same day, May 19, 2022. The hospital bed and the oxygen tank that had been provided by the previously contracted hospice agency were not removed until June 15, 2022 by the supplier due to delays in communication between the facility and both outside agencies. Although the hospice items remained at the facility for almost four weeks, they were not personal property nor the responsibility of the resident or resident’s responsible parties.

The Department has investigated the allegation of Licensee did not provide responsible party with a refund. Based on evidence obtained, the allegation is substantiated which means that the allegation is valid because the preponderance of the evidence standard has been met. A deficiency is cited in accordance of California Code of Regulations, Title 22, Division 6 Chapter 8, and listed on the 9099D.

An exit interview was conducted with Licesenee, Tapia a copy of this report, confidential names list, LIC 9099D and Licensee/Appeals Rights (LIC 9058 01/16) was provided to Licensee.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20220614141111

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: SUNSET COAST ASSISTED LIVING	FACILITY NUMBER: 374604347
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/28/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/28/2022 Section Cited HSC 1569.652	1 2 3 4 5 6 7	H&SC 1569.652(c) A refund of any fees paid in advance ... after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, ... if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated they will pay R1’s responsible party’s refund by July 11, 2022.
	8 9 10 11 12 13 14	Based on interviews and record reviews the licensee did not issue a refund to the responsible party within 15 days after R1’s personal property was removed. This posed a potential personal rights risk to one out of three residents in care	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

LIC9099 (FAS) - (06/04)

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