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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604533
Report Date: 12/05/2023
Date Signed: 12/05/2023 06:15:28 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
03/13/2023 and conducted by Evaluator Nacole Patterson
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230313085404
FACILITY NAME:SANTIANNA OAKMONT SIGNATURE LIVINGFACILITY NUMBER:
374604533
ADMINISTRATOR:THARP, CHRISTOPHERFACILITY TYPE:
740
ADDRESS:2560 FARADAY AVETELEPHONE:
(442) 325-8090
CITY:CARLSBADSTATE: CAZIP CODE:
92010
CAPACITY:226CENSUS: 164DATE:
12/05/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sam El Rabaa, Executive Director TIME COMPLETED:
06:20 PM
ALLEGATION(S):
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Staff did not allow residents to have access to their rooms.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Executive Director Sam El Rabaa.

On 3/13/23 it was alleged that staff did not allow residents access to their rooms in the Memory Care unit. The Department’s investigation consisted of unannounced facility visits, review of facility and outside source records, interviews with facility staff, residents, outside sources, and LPA direct observations. Staff interview revealed that residents were allowed access to their rooms upon request, as the first floor rooms were sometimes locked due to a high concentration of wandering residents entering open rooms. Staff interview further revealed that staff would walk around and assist residents with room entry when needed and upon request. Outside source interviews did not corroborate the allegation, informing that while certain resident rooms were locked, residents were not observed waiting for long periods of time to access their rooms.
(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
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 5
Control Number 08-AS-20230313085404
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SANTIANNA OAKMONT SIGNATURE LIVING
FACILITY NUMBER: 374604533
VISIT DATE: 12/05/2023
NARRATIVE
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(Continued from LIC9099)

During an unannounced facility visit LPA directly observed caregivers entering resident rooms freely, without the use of a key. LPA directly observed staff testing, at random, both resident and bathroom doors; none were observed to be locked. The resident in question was unable to be interviewed due to diminished cognition.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation(s) occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Executive Director Sam El Rabaa, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
03/13/2023 and conducted by Evaluator Nacole Patterson
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230313085404

FACILITY NAME:SANTIANNA OAKMONT SIGNATURE LIVINGFACILITY NUMBER:
374604533
ADMINISTRATOR:THARP, CHRISTOPHERFACILITY TYPE:
740
ADDRESS:2560 FARADAY AVETELEPHONE:
(442) 325-8090
CITY:CARLSBADSTATE: CAZIP CODE:
92010
CAPACITY:226CENSUS: 164DATE:
12/05/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sam El Rabaa, Executive Director TIME COMPLETED:
06:20 PM
ALLEGATION(S):
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9
Staff did not meet resident(s) basic needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Executive Director Sam El Rabaa.

On 3/13/23 it was alleged that staff did not meet resident(s) basic needs due to low staffing. The Department’s investigation consisted of unannounced facility visits, review of facility and outside source records, interviews with facility staff, residents, and outside sources. Staff interview corroborated that, during the timeframe of the complaint, residents did wait long periods of time for meals to be served in the dining room, and to be assisted with incontinence care. Outside source interview corroborated the allegation, informing direct observations of residents waiting approximately 45 minutes for meals, after being seated. Outside source interview further revealed visual observations of unmanaged incontinence care for long periods of time.

(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20230313085404
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SANTIANNA OAKMONT SIGNATURE LIVING
FACILITY NUMBER: 374604533
VISIT DATE: 12/05/2023
NARRATIVE
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(Continued from LIC9099)

Based on relevant interviews and records review, the preponderance of evidence has been met that alleged violation occurred and is therefore substantiated. Deficiencies are cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Executive Director Sam El Rabaa, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Citations on this Visit Report are Under Appeal!

Control Number 08-AS-20230313085404
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SANTIANNA OAKMONT SIGNATURE LIVING
FACILITY NUMBER: 374604533
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
12/15/2023
Section Cited
CCR
87468.2(a)(4)
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...Residents in privately operated residential care facilities for the elderly shall have the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers. This requirement was not met, evidenced by:
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Licensee provided proof during the facility visit of additional staff members hired to provide additional care to Memory Care residents. Licensee with continue to utilize registry staff to ensure sufficient numbers to meet residents' basic needs.
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Based on interviews and records review, Licensee did not employ staff sufficient in numbers to provide care, supervision, and services to meet resident individual needs. This posed a potential safety and personal rights risk to 34 of 34 residents 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: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5