374604538-11-29-2023-08-AS-SJAB-CY42JV-20231130162657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604538
Report Date: 11/29/2023
Date Signed: 11/29/2023 03:54:31 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
10/20/2023 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20231020145534

FACILITY NAME:	RANCHVIEW SENIOR ASSISTED LIVING		FACILITY NUMBER:	374604538
ADMINISTRATOR:	SETTINERI, JEFFREY		FACILITY TYPE:	740
ADDRESS:	350 COLE RANCH ROAD		TELEPHONE:	(760) 717-4088
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	42	CENSUS: 24	DATE:	11/29/2023
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Wendy Diaz Manager		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff are using a belt to restrain resident in a chair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver the finding in the above mention complaint allegations. LPA Domingo identified herself and discussed the purpose of the visit with Manager Wendy Diaz.

During the investigation, LPA Domingo collected pertinent resident records as well as facility documentation and conducted interviews with staff, residents and outside sources.

It was alleged that staff were using a belt to restrain a resident in a chair. LPA Domingo observed 4 Residents during meal time. Resident 1 (R1) through Resident 3 (R3) (See LIC811 Confidential Names list). Resident 1 (R1) was observed with a soft positioning foam. R1's medical record was reviewed and there was an order for the soft positioning foam to be used.

Continue on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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-20231020145534

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: RANCHVIEW SENIOR ASSISTED LIVING	FACILITY NUMBER: 374604538
	VISIT DATE: 11/29/2023

NARRATIVE

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[Continued from LIC9099]

Resident 2 (R2) was observed to have a side positioning foams while sitting in the wheelchair.
R2 medical record was reviewed and there was a Doctor's order for the side positioning cushions. Resident 3 (R3) was observed to have a safety belt around the body. LPA Domingo observed closer and the safety belt was a positioning cushion that was holding the cushion on the wheelchair. R3's records were reviewed and there was a Doctor's order for the positioning cushion that was being held in place with a safety belt which was not around R3's body. LPA Domingo observations of R1 through R3 concur with the Medical Record and Doctor's orders for the positioning cushions. Interview with outside source 1 (OS1) observed resident's with the safety cushions being held onto the wheelchair was positioning. OS1 confirmed that there was no observation of staff using a belt to restrain residents. Interview with outside source 2 (OS2) stated that that there was never any observations of staff using a belt to restrain a resident.

Based on LPA's observations and interviews with outside sources and records reviewed there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with the Manager Wendy Diaz, 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: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC9099 (FAS) - (06/04)

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