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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604411
Report Date: 05/23/2024
Date Signed: 05/24/2024 09:26:29 AM


Document Has Been Signed on 05/24/2024 09:26 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:LA MAREA SENIOR LIVINGFACILITY NUMBER:
374604411
ADMINISTRATOR:GREGORY CASEFACILITY TYPE:
740
ADDRESS:5592 EL CAMINO REALTELEPHONE:
(442) 325-3510
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:125CENSUS: 78DATE:
05/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Executive Director Gregory CaseTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Executive Director Gregory Case.

Today's visit was in response to a licensee self-reported medication error. An Unusual Incident Report was received at the CCLD San Diego Regional Office on 05/17/2024. [See LIC 811 Confidential Names List for a description of residents]. Per the self-reported document, on 05/10/24 during the evening shift, nine (9) residents missed their medications due to staff inability to meet the two hour time frame of medication assistance.

During today’s visit, LPA performed a brief welfare check on residents, finding no safety concerns. LPA interviewed Executive Director Gregory Case and Regional Clinical Specialist Joanne Gomez regarding the incident. A facility internal investigation was conducted and it was concluded that the error occurred due to the facility experiencing a shortage of staff. Immediately after the incident, all of the residents’ Primary Care Physicians and Responsible Parties were informed. No resident experienced adverse effects from the error. The facility implemented a plan to hire extra Med Tech staff as back-up. The facility also conducted an in-service training on proper medication management procedures for all staff responsible for handling medications.

One (1) deficiency was cited per California Code of Regulations, Title 22, (refer to the attached LIC 809-D page). A Plan of Correction was jointly developed with the Executive Director.

An exit interview was conducted with Gregory, whose signature below confirms receipt of a copy of this report, the LIC811 and the Licensee Rights (LIC 9058 01/16).

SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 05/24/2024 09:26 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: LA MAREA SENIOR LIVING
FACILITY NUMBER: 374604411

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/24/2024
Section Cited
CCR
87465(c)(2)

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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by:
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The licensee conducted an in-service training with staff on 05/16/24 on proper medication management protocols. The licensee has also hired new Med Tech staff as back-up for emergencies.
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Based on records and interviews, the licensee did not ensure that 9 of 24 residents were assisted as needed with self-administration of prescription medications on 05/10/24, which posed a potential health 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.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2024
LIC809 (FAS) - (06/04)
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