374604533-10-21-2024-08-AS-LTEZ-DAKVDM-20241031162057

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604533
Report Date: 10/21/2024
Date Signed: 10/21/2024 02:31:27 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
10/16/2024 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20241016001550

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: 167	DATE:	10/21/2024
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Executive Director Sam El-Rabaa		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Licensee did not prevent a resident from eloping from the facility
Licensee did not arrage psychiatric medical care for residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to initiate an investigation in the above-mentioned allegations. LPA identified herself and discussed the purpose of the visit with Executive Director Sam El-Rabaa.

On October 16, 2024, Community Care Licensing (CCL) received a complaint alleging licensee did not prevent Resident 1 (R1) from eloping from the facility and licensee did not arrange psychiatric medical care for R1. According to R1’s Physician Report signed October 3, 2024, R1 is diagnosed with a major neurocognitive disorder that affects communication, cannot leave facility unassisted and does not have aggressive or wandering behaviors. Additionally, R1 records collected revealed that R1 did not have history of exit seeking or aggressive behaviors.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024

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-20241016001550

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: 10/21/2024

NARRATIVE

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During the investigation, LPA Strong collected pertinent resident records as well as facility documentation and conducted interviews. According to the allegation, R1 left the facility on October 14, 2024, and emergency personnel were not contacted until R1 was roughly one mile away from the building. Records collected revealed that on October 14, 2024, R1 attempted to leave the facility unassisted and was followed by staff. Records revealed that R1 was followed for roughly two and a half miles and attempts for redirection were made but not successful. Interviews with staff present revealed that R1 was agitated and aggressive on the date of the incident. Interviews also revealed that R1 was not left unsupervised as S1 and S2 stayed with R1. Records also revealed that R1 was provided emergency medical care on October 14, 2024. Interview with outside source confirmed R1 was not left unattended during exit seeking incidents.

It was also alleged that R1 was not provided with psychiatric care prior to above mentioned incident. Records collected revealed R1 agreement was signed on September 30, 2024, two weeks prior to incident mentioned above, and there was no known history of exist seeking or aggressive behaviors. Interview with Executive Director revealed R1 physically moved into the facility on October 4, 2024. Interviews revealed that R1’s behaviors began after date of move in and communication to responsible party and primary care provider had been made. Records showed that R1 was reassessed as of October 9, 2024, for extensive new behaviors. Additionally, interview with outside source confirmed there had been no history of exit seeking behaviors or aggressiveness requiring psychiatric care.

Based on LPA's interviews, and record reviews there is not a preponderance of evidence to prove alleged violations 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 (LIC 9058 03/22) were provided.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024

LIC9099 (FAS) - (06/04)

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