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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604411
Report Date: 03/27/2024
Date Signed: 03/27/2024 06:30:11 PM


Document Has Been Signed on 03/27/2024 06:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 87DATE:
03/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Executive Director Gregory CaseTIME COMPLETED:
06:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Gregory Case.

Today's visit was in response to two (2) LIC624 Incident Reports, which Licensee self-submitted to the CCLD San Diego Regional Office (both were received on 02/09/2024).

According to the LIC624s: On 02/06/2024, facility management first became aware of allegations of Staff #1’s (S1’s) mistreatment of residents. Specifically, it was alleged that S1 handled Resident #1 (R1) roughly during personal care and that S1 intentionally gave Resident #2 (R2) a cold shower. [See LIC 811 Confidential Names List for a description of select person identifiers used in this report]. Upon receiving these allegations, Licensee immediately suspended S1’s employment pending further investigation.

During today’s visit, LPA performed a brief facility tour and welfare check on select residents in care. LPA collected copies of and reviewed pertinent care and personnel records, as well as handwritten and signed statements from staff (which Licensee’s collected during its own internal investigation). LPA also independently interviewed multiple relevant staff.


[CONTINUED ON LIC 809-C, 1 of 2]

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: LA MAREA SENIOR LIVING
FACILITY NUMBER: 374604411
VISIT DATE: 03/27/2024
NARRATIVE
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[CONTINUED FROM LIC 809]

According to R1’s Facesheet and LIC602 Physician’s Report (dated 08/28/2023), R1’s diagnoses included Dementia and “hemiplegia and hemiparesis following cerebral infarction [i.e., stroke].” R1’s Service Agreement with Licensee (i.e., care plan) showed that they required assistance of two (2) staff with incontinence care and dressing, among other needs. According to R2’s Facesheet and LIC602 Physician’s Report (dated 07/24/2023), R2’s diagnoses included Dementia. R1’s Service Agreement with Licensee showed that they required staff assistance with bathing, among other needs. According to R3’s Facesheet and LIC602 Physician’s Report (dated 02/01/2023), R3’s diagnoses included Dementia and Insomnia.

Records showed that R1 had lived at the facility since 06/04/2022, while S1 had worked at the facility since 12/07/2022. Staff interviews widely corroborated that R1 experienced limited flexibility in their legs due to their underlying condition. Sometime between late January and early February 2024, there was an occasion when S1 quickly/forcefully opened R1’s legs while they attempted to provide incontinence care to R1, causing R1 to cry out in pain. This was witnessed by Staff #2 (S2) the only other person in the room at that time. Staff #3 (S3) and Staff #4 did not witness the above incident, but each described a separate occasion where they witnessed S1 refuse to provide personal care to S1 (for which other facility staff had to step in to help S1).

According to records and staff interviews, during the same general time frame: There was a day when S1 gave R2 a shower using cold water. After R2 yelled out in protest, S2 intervened to pause the shower until the water could be warmed up. The cold shower incident was witnessed by both S2 and S3. Lastly, there was a morning when S2 saw S1 exit R3’s bedroom. S1 told S2 that R3 refused to get up out of bed. When S2 went into R3’s bedroom, they found R3 curled up in bed cold, with their blankets on the floor and their bedroom window left open. S3 was on duty at the time, and while they did not personally enter R3’s bedroom, they corroborated that S2 expressed to them that same day their concern about what they witnessed.


[CONTINUED ON LIC 809-C, 2 of 2]
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: LA MAREA SENIOR LIVING
FACILITY NUMBER: 374604411
VISIT DATE: 03/27/2024
NARRATIVE
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[CONTINUED FROM LIC 809-C, 1 of 2]

Due to their baseline memory loss, R1, R2, and R3 were unable to be interviewed.

Personnel records showed: S1’s employment at the facility was suspended starting 02/06/2024. S1’s employment was subsequently involuntarily terminated on the basis that Licensee’s investigation concluded S1 had participated in “Patient Abuse/Neglect.”

Per records, Licensee reported the respective incidents involving S1 against R1 and R2 to CCLD, the local Long Term Care Ombudsman Program (LTCOP), local law enforcement, and those residents’ responsible persons (RPs), as was required. However, Licensee did not submit a written report to the Department describing the alleged incident involving S1 and R3, as was required, despite gaining constructive knowledge of this latter allegation on 02/06/2024.

Two (2) deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). Since one of the deficiencies is a repeat violation within a twelve (12) month period of time, a civil penalty of $250 was also assessed (refer to the LIC421-FC). Plan of Corrections were jointly developed with the Licensee.

An exit interview was conducted with Case, to whom a copy of this report, the LIC 809-D, the LIC421-FC, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 03/27/2024 06:30 PM - 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: LA MAREA SENIOR LIVING
FACILITY NUMBER: 374604411

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/28/2024
Section Cited
CCR
87468.2(a)(8)

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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: “(a)…residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect,…punishment,…mental, physical…abuse.”
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According to personnel records, R1’s last day of employment at the facility was 02/05/2024 and they will not return. This resolves the immediate risk. Licensee agreed to retrain all remaining staff on Resident’s Personal Rights (as articulated in form LIC613-C). Licensee agreed to E-mail the training sign-in sheet to LPA, by 04/26/2024.
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This requirement was not met, as evidenced by: Based on records and interviews, Licensee’s staff (S1) did not ensure that 3 of 87 residents (R1, R2, and R3) were free from neglect, punishment, and/or mental/physical abuse. This posed an immediate health and personal rights risk to persons in care.
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Type B
03/29/2024
Section Cited
CCR87211(a)(1)(D)

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87211 Reporting Requirements: "(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified...(D) Any incident which threatens the welfare, safety or health of any resident."
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On 02/15/2024, Licensee coordinated with the local Long Term Care Ombudsman to have its staff retrained on Mandated Reporting Requirements. Licensee agreed to submit a written report describing the incident between S1 and R3 to CCLD, LTCOP, and R3’s responsible person, by the POC due date.
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This requirement was not met, as evidenced by: Based on records and interviews, 1 of 87 residents (R3) had an incident which threatened their welfare, safety, or health, and Licensee did not submit a written report of the incident to CCLD and the residents’ responsible person within seven days. This posed a potential 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.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
LIC809 (FAS) - (06/04)
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