374604533-3-26-2024-08-AS-JLOT-D4TTH7-20240430144415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604533
Report Date: 03/26/2024
Date Signed: 03/26/2024 04:22:18 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
12/20/2023 and conducted by Evaluator Nacole Patterson

COMPLAINT CONTROL NUMBER: 08-AS-20231220081633

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: 163	DATE:	03/26/2024
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Executive Director Sam El Rabaa		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff slept on duty resulting in lack of supervision.
Licensee did not follow resident's care plan.
Licensee did not ensure resident rooms were kept clean.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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 12/20/23 it was alleged that staff slept on duty resulting in lack of supervision, Licensee did not follow resident's care plan, and Licensee did not ensure resident rooms were kept clean. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, records review, and LPA direct observations.

Staff interview revealed that an internal investigation was conducted by the Memory Care Director regarding nocturnal (NOC) shift staff sleeping during their shift, and no evidence was found that staff were sleeping during their scheduled work time.
(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)

Page: 1 of 3

Control Number 08-AS-20231220081633

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SANTIANNA OAKMONT SIGNATURE LIVING	FACILITY NUMBER: 374604533
	VISIT DATE: 03/26/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Continued from LIC9099 p.1)

The internal investigation included random, unannounced visits during the NOC shift, interviews with NOC shift staff, and review of electronic clock in/out times. Staff interview revealed that staff were permitted to sleep during their scheduled breaks due to it being personal time. Staff interview further revealed observations of resident needs being met during each shift, regardless of the time of day. Resident interviews did not corroborate the allegation, as residents confirmed that staff met their needs with no exception for the time of day. Outside source interviews did not corroborate the allegation, informing of regular facility visits during the NOC shift, with no staff observed to be sleeping. Records review did not corroborate the allegation, revealing daily End of Shift reports for NOC shift during the month of concern with detailed reporting regarding resident care and incidents for follow-up.

Regarding the allegation, "Licensee did not follow resident's care plan", it was alleged that staff did not conduct 1-hour status checks on resident 1 (R1) per their care plan. Review of R1's records did not corroborate the allegation, as no records were found to prove that R1's care plan stated hourly checks. Review of facility records revealed that R1 was monitored at regular intervals and assisted with their needs. Records review further revealed that R1 suffered from sleeping issues and was frequently combative during the early morning. Outside source interview did not corroborate the allegation, informing that a visit was conducted with R1 during the timeframe of complaint and R1 was observed to be clean with no issues. During an unannounced facility visit, LPA directly observed R1 participating in group activities and eating dinner with other residents; LPA did not observe R1 in their room unassisted at any time during the visit. Additional observations revealed that residents were together in the common areas most of the day due to the structure of programming, and LPA did not observe an opportunity for R1 to be by themselves without a staff member nearby. Due to their baseline memory loss, R1 was not able to participate as a valid historian for interview.

Regarding the allegation, "Licensee did not ensure resident rooms were kept clean", staff interview revealed that housekeepers and caregivers were responsible for maintaining resident rooms. Caregivers removed trash in resident rooms 2-3 times per shift due to soiled incontinence supplies, and also organized the rooms. Housekeeping made the beds and cleaned the rooms.

(Continued on LIC9099-C p.3)

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20231220081633

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SANTIANNA OAKMONT SIGNATURE LIVING	FACILITY NUMBER: 374604533
	VISIT DATE: 03/26/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Continued from LIC9099-C p. 2)

Staff interview further revealed that due to the nature of the memory care population served, it was not uncommon to see random items out of place in resident rooms. Outside source interviews did not express concern regarding cleanliness or sanitation of resident rooms. Residents interviewed informed that staff cleaned their rooms daily and that the rooms were "immaculate". During an unannounced facility visit LPA directly observed 6 resident rooms; LPA did not observe any room to be cluttered, in disarray, or unsanitary. LPA observed 1 unmade bed and one small pile of clothing outside of a laundry basket. LPA did not observe any room that looked as if it had not recently been cleaned.

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: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3