374604404-2-7-2024-08-AS-JLOT-D2Q2HA-20240222162423

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604404
Report Date: 02/07/2024
Date Signed: 02/07/2024 05:11:42 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
02/02/2024 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20240202154024

FACILITY NAME:	TRUEWOOD BY MERRILL, OCEANSIDE		FACILITY NUMBER:	374604404
ADMINISTRATOR:	MCBRIDE, FERLINA		FACILITY TYPE:	740
ADDRESS:	3500 LAKE BOULEVARD		TELEPHONE:	(206) 676-5300
CITY:	OCEANSIDE	STATE:	ZIP CODE:	92056
CAPACITY:	175	CENSUS: 120	DATE:	02/07/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Assistant Executive Director Fred Paoli		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Facility staff did not have a criminal record clearance

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to conduct an investigation regarding the above mentioned allegation. LPA was greeted by, identified herself to, and explained the purpose of the visit and the basic elements of the complaint with Assistant Executive Director Fred Paoli. LPA spoke with Administrator Ferlina McBride via telephone.

During today’s visit, LPA toured the facility, observed residents in care, reviewed and obtained copies of facility records, and interviewed residents and staff.

It was alleged that facility staff were working without a criminal record clearance. A tour of the facility and review of staffing schedule and roster revealed that multiple staff members were present at the facility during LPA's visit who were not associated to the facility.
Continued on LIC9099-C page...

Substantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

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-20240202154024

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: TRUEWOOD BY MERRILL, OCEANSIDE	FACILITY NUMBER: 374604404
	VISIT DATE: 02/07/2024

NARRATIVE

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Interviews with facility management revealed that Staff 1, Staff 2, Staff 3 and Staff 4 (S1-S4) had been working at the facility for more than 5 days and were present and working during LPA's visit. [Resident Services Director was provided with an LIC811 Confidential Names List to identify S1-S4]. S4 was not present during the visit but interviews confirmed that S4 had been working at the facility for more than 5 days. A review of the Department Personnel List revealed that S1, S2, S3, and S4 were not associated to the facility at the time of LPA's visit.

The Department has investigated the above mentioned allegation and based on interviews and records review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency is cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page. In addition, civil penalties are being assessed for un-associated staff working at the facility and are noted on the attached LIC421BG in the amount of $2,000.

An exit interview was conducted with Administrator Ferlina McBride via telephone and Resident Services Director Theresa "Tee" Roberts, whose signature below confirms receipt of a copy of this report, the LIC811, the LIC421BG and the Licensee Appeal Rights (LIC9058 01/16).

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240202154024

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: TRUEWOOD BY MERRILL, OCEANSIDE	FACILITY NUMBER: 374604404
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/07/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/09/2024 Section Cited CCR 87355(e)(2)	1 2 3 4 5 6 7	87355 (e) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance...This requirement has not been met as evidenced by:	1 2 3 4 5 6 7	LPA verified that S1-S4 left the facility prior to the conclusion of LPA's visit. Administrator will review list of currently associated staff and submit criminal record transfers for any missing staff. Administrator will submit criminal record transfers for S1-S4 to the Department by POC due date of 2/9/2024.
	8 9 10 11 12 13 14	Based on interviews and records review, the Licensee did not comply with the above regulation as S1, S2, S3, and S4, were working without being associated to the facility. This poses an immediate safety concern to 120 of 120 residents.	8 9 10 11 12 13 14	This is an amended version of the original report dated 2/7/2024.
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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.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC9099 (FAS) - (06/04)

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