374604586-8-23-2022-08-AS-LTEZ-CHTVY7-20220831165041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604586
Report Date: 08/23/2022
Date Signed: 08/23/2022 09:31:54 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/15/2022 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20220815163835

FACILITY NAME:	ELDERLY HAVEN		FACILITY NUMBER:	374604586
ADMINISTRATOR:	AKHTER-RAHMAN, SYEEDA SELI		FACILITY TYPE:	740
ADDRESS:	10163 EMBASSY WAY		TELEPHONE:	(858) 688-4667
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	6	CENSUS: 5	DATE:	08/23/2022
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Administrator, Syeeda Selina Akhter-Rahman		TIME COMPLETED:	05:36 PM

ALLEGATION(S):

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-Facility staff did not meet resident's incontinence needs
-Licensee did not maintain a comfortable temperature for residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced complaint investigation visit. LPA was greeted and allowed entry into the facility by staff, Merlina Aquino. LPA discussed the allegations mentioned above with Administrator, Syeeda Selina Akhter-Rahman

During today's visit, LPA toured the facility, requested records, and interviewed staff, residents, and outside sources. It was alleged the facility staff did not meet the incontinent needs of a resident by allowing the resident to sit in a soggy diaper. Administrator's interview revealed staff are required to check resident's every two hours for incontinent needs. Staff interviews confirmed they are required to check the residents every two hours and they comply. Additional staff interviews revealed they take turns checking on the residents and don't only change their diapers but also clean the residents with soap and water. LPA observed two different staff members changing diapers for two different residents and observed the residents being checked on again during a two hour duration. Outside source interviews revealed there was one occasion when a resident had a soiled diaper on but the time frame was unknown of when the resident was last checked and it's possible the resident was just about to be changed. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

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-20220815163835

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ELDERLY HAVEN	FACILITY NUMBER: 374604586
	VISIT DATE: 08/23/2022

NARRATIVE

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Further outside sources revealed the residents have not been witnessed with having a soggy or soiled diaper and the facility is clean with no urine odor. Resident interviews revealed staff are changing their diapers.

It was also alleged the licensee is not maintaining a comfortable temperature for the residents. An internet search of the Weather, using the official Weather Application reflected today's temperature in this area is 79 degrees. During today's visit the temperature measured at 81 degrees F., which was within regulation. Administrator's interviews revealed there are ceiling fans in the resident's room along with floor fans. LPA observed the ceiling fans in use and some floor fans. The administrator observed a resident's fan was off and she inquired with the resident why the fan was not in use. Resident responded because there is a nice breeze with the windows and doors open and the fan was making them cold. Some residents stated they were cold and were witnessed under blankets.

Based on observations and interviews, the investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Administrator, Syeeda Selina Akhter-Rahman whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

LIC9099 (FAS) - (06/04)

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