374604533-12-7-2023-08-AS-JLOT-CYYVWS-20231229154826

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604533
Report Date: 12/07/2023
Date Signed: 12/07/2023 12:33:26 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
11/29/2023 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20231129120604

FACILITY NAME:	SANTIANNA OAKMONT SIGNATURE LIVING		FACILITY NUMBER:	374604533
ADMINISTRATOR:	EL RABAA, SAM		FACILITY TYPE:	740
ADDRESS:	2560 FARADAY AVE		TELEPHONE:	(442) 325-8090
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92010
CAPACITY:	226	CENSUS: 164	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Sam El Rabaa, Executive Director		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Licensee did not follow physician's orders.
Licensee obtained a Home Health service provider without consent.
Licensee did not allow Home Health agency to visit resident.

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 11/29/23 it was alleged that Licensee did not follow physician's orders, Licensee obtained a Home Health service provider without consent, and Licensee did not allow a Home Health agency to visit a resident. The Department’s investigation consisted of unannounced facility visits, review of facility and outside source records, interviews with facility staff, and outside sources.

Regarding the allegation, "Licensee did not follow physician's orders", it was alleged that the Licensee did not provide the care instructed by a physician to a resident for a healing wound.

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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-20231129120604

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: 12/07/2023

NARRATIVE

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(Continued from LIC9099)

Staff interview revealed that the wound care instructed by the physician was not care that facility staff could provide, due to not being a medical facility. Staff interview further revealed that the Licensee assisted the resident with obtaining Home Health agency services to provide the care required. Records review revealed that the Home Health agency came to the facility and administered wound care to the resident.

Regarding the allegation, "Licensee obtained a Home Health service provider without consent", it was alleged that the Licensee did not allow the resident and/or responsible party to be involved in the resident's healthcare decision making. Staff interview revealed that the Licensee assisted the resident in finding a Home Health agency, and the resident in question signed consent for care from the agency. Records review corroborated the staff statements, revealing signed consent forms by the resident for the Home Health agency to provide the required care. Outside source interview also corroborated staff statements, informing that the resident directly consented for care, in writing.

Regarding the allegation, "Licensee did not allow Home Health agency to visit resident", it was alleged that the Licensee turned away a Home Health agency who came to provide care to a resident. Staff interview did not corroborate the allegation, staff stating that no Home Health agencies have been denied access to provide care to any resident. Records review revealed that the resident in question refused care from the Home Health agency directly on the day in question; the Home Health agency returned to the facility the next day, and was granted access by the facility and resident to provide care. Outside source interview did not corroborate the allegation, revealing that the Home Health agency was granted access to the resident and care was provided.

Based on interviews, and records review, a preponderance of evidence does not exist to prove that the alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Sam El Rabaa, Executive Director, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

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