374604539-10-12-2023-08-AS-SJAB-CX5V9E-20231031161412

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604539
Report Date: 10/12/2023
Date Signed: 10/12/2023 02:25:29 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
09/08/2023 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230908130435

FACILITY NAME:	PACIFICA SENIOR LIVING ENCINITAS		FACILITY NUMBER:	374604539
ADMINISTRATOR:	WATKINS, MELISSA		FACILITY TYPE:	740
ADDRESS:	504 S EL CAMINO REAL		TELEPHONE:	(760) 452-0615
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	90	CENSUS: 60	DATE:	10/12/2023
		UNANNOUNCED	TIME BEGAN:	11:43 AM
MET WITH:	Executive Director Melissa Watkins		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Licensee did not follow infection control protocol for scabies outbreak
Licensee did not administer medication as prescribed
Licensee did not follow outbreak notification protocol

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 Melissa Watkins and Mayra Macedo, Resident Services Coordinator.

On 9/8/23 it was alleged that the Licensee did not follow the facility's infection control protocol for scabies, did not administer medication as prescribed, and did not follow outbreak notification protocol. The Department’s investigation consisted of unannounced facility visits, review of facility and outside source records, interviews with facility staff, residents, outside sources, and LPA direct observations.

Regarding the first allegation, "Licensee did not follow infection control protocol for scabies outbreak", it was alleged that the Licensee did not take steps to prevent a scabies outbreak from occurring. Staff interview revealed that facility staff enacted infection control protocols upon receiving notice of a possible Scabies case at the facility.
(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: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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-20230908130435

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: PACIFICA SENIOR LIVING ENCINITAS	FACILITY NUMBER: 374604539
	VISIT DATE: 10/12/2023

NARRATIVE

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(Continued from LIC9099)

Staff interview revealed that all staff members were briefed and trained on infection control protocols and management was made aware of any potential Scabies case as soon as it was observed. Staff interview revealed that the facility was utilizing PPE during the timeframe of the complaint due to a Covid outbreak at the facility. Staff interview further revealed that some of the suspected cases were misdiagnosed by resident physicians and treatment for certain Scabies cases was delayed. The Licensee did not have confirmation that the facility had reached outbreak status for Scabies during the timeframe of the complaint. All staff interviewed explained the same, consistent, infection control protocol for scabies. Residents interviewed stated that facility staff took precautions and followed protocols for both the Covid outbreak and the Scabies cases. No residents interviewed expressed concern for the way the Licensee handled the Scabies cases at the facility. Outside sources did not corroborate that the facility had reached outbreak status for Scabies, and stated they did not have concerns regarding how the Licensee enacts infection control protocols. Records review revealed that the facility's Infection Control Plan matched the protocol that staff recited during interviews.

Regarding the second allegation, "Licensee did not administer medication as prescribed", it was alleged that facility staff did not apply a medication properly on a resident (R1). Staff interview did not reveal that the medication in question was applied to R1 outside of the prescription. Staff members interviewed consistently described the administration instructions of the medication in question. Interview with R1 and other residents who received the same medication revealed no concerns with any administration of the medication in question. Outside source interview revealed no concerns or knowledge of errors regarding medication administration at the facility. Records review revealed that the application instructions for the medication in question matched the administration instructions that staff verbalized.

Regarding the third allegation, "Licensee did not follow outbreak notification protocol", it was alleged that Responsible Parties and Community Care Licensing were not notified of a scabies outbreak. Staff interview revealed that while the facility had confirmed Scabies cases and some residents were being treated as a precaution due to exposure, the Licensee did not have confirmation that the facility was in an outbreak. Staff interview revealed that the Executive Director was in communication with Public Health regarding Scabies infection control.

(Continued on LIC9099-C)

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230908130435

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: PACIFICA SENIOR LIVING ENCINITAS	FACILITY NUMBER: 374604539
	VISIT DATE: 10/12/2023

NARRATIVE

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(Continued from LIC9099-C)

Staff interview further revealed that the official notification protocol was not enacted because an outbreak had not been determined, but residents were provided information on Scabies symptoms. Outside source interview revealed no concerns regarding the Licensee's infection control notification protocols. Records review did not show that the Licensee has failed to report confirmed outbreaks to necessary parties and agencies when required.

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 Resident Services Coordinator Mayra Macedo, 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: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC9099 (FAS) - (06/04)

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