374604533-3-18-2024-08-AS-JLOT-D4TNXG-20240430105106

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604533
Report Date: 03/18/2024
Date Signed: 03/18/2024 05:28:42 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
12/12/2023 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20231212084105

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: 162	DATE:	03/18/2024
		UNANNOUNCED	TIME BEGAN:	04:45 PM
MET WITH:	Executive Director Sam El Rabaa		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Licensee did not maintain resident’s hygiene.
Licensee did not assist resident with medical care for a pressure sore.

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 themselves and disclosed the purpose of the visit to Executive Director Sam El Rabaa.

On 12/12/23 it was alleged that Licensee did not maintain resident’s (R1) hygiene, and did not assist resident (R1) with medical care for a pressure sore. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review. Staff interview revealed that R1 frequently refused to be showered by staff. Regarding hygiene, staff interview revealed that the Licensee was in communication with the family regarding the refusals, and made scheduling adjustments to increase R1's consent to specific staff for showers. Due to no longer living at the facility and their baseline memory loss, R1 was unable to participate as a reliable historian/interviewee about the incident.

(Continued on LIC9099-C p.2)

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: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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-20231212084105

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: 03/18/2024

NARRATIVE

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(Continued from LIC9099 p.1)

Outside source interview did not express concern regarding resident personal care at the facility, informing that residents were clean and groomed during visits in the timeframe of concern. Review of facility records showed that staff made regular attempts to shower R1 with mixed results of success. Body checks and end of shift reports revealed that attempts were made to shower R1, resulting in both consent and refusals. The records showed that staff did attempt to shower R1, per their care agreement.

Regarding the pressure sore, staff interview revealed that staff were aware of and elevated observations about redness and/or dryness developing on R1's coccyx. Staff communicated the issue to R1's physician and received prescription barrier cream, however, the cream arrived after R1 had already been moved from the facility. Records review corroborated staff statements that the Licensee notified R1's PCP regarding skin breakdown and received a response with a medication order after the resident moved out. Outside source interviews revealed that R1's sore was at the lowest measurable stage and not severe, and R1 was receiving medication and services for it prior to transferring to the new facility.

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 allegations are 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 Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC9099 (FAS) - (06/04)

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