374604663-7-17-2024-08-AS-JLOT-DAKVWK-20241031164801

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604663
Report Date: 07/17/2024
Date Signed: 07/17/2024 12:59:16 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
07/03/2024 and conducted by Evaluator Nacole Patterson

COMPLAINT CONTROL NUMBER: 08-AS-20240703162544

FACILITY NAME:	PARADISE VIEW HOME III		FACILITY NUMBER:	374604663
ADMINISTRATOR:	PASCUAL, BESSIE		FACILITY TYPE:	735
ADDRESS:	7373 WESTBROOK AVE.		TELEPHONE:	(619) 634-3410
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92139
CAPACITY:	6	CENSUS: 4	DATE:	07/17/2024
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Administrator Bessie Pascual		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Licensee did not centrally store resident's medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Administrator Bessie Pascual.

On 7/3/24 it was alleged that the Licensee did not centrally store medication for Resident 1 (R1). The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, records review, and direct LPA observations.

Resident and staff interviews revealed that resident medications for Veteran's Afairs (VA) clients were mailed to the facility in each resident's name. Residents were able to collect their mail from the mailbox, and gave their medications to staff for them to be centrally stored. Staff interviews revealed that R1 had been refusing most of their medications for two (2) weeks, which resulted in behavior and mood changes.
(Continued on LIC9099-C p.2)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

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-20240703162544

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: PARADISE VIEW HOME III	FACILITY NUMBER: 374604663
	VISIT DATE: 07/17/2024

NARRATIVE

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(Continued from LIC9099 p.1)

Staff interviews informed that staff discovered one of R1's prescriptions to be missing, and upon investigation it was found that R1 had taken the prescription to their room, having refused to give them to staff. Staff interviews further revealed that staff took timely action upon the medication discovery, and were also in regular contact with R1's Case Manager about R1's behaviors and missing medication. R1 was not able to be interviewed due to being away from the facility during the facility visit. Interview with R1's Case Manager corroborated staff statements that the Case Manager was informed of the missing medication, medication refusals, and behavior changes.

Records review corroborated staff statements regarding R1's medication refusals. R1's Medication Administration Record showed medication refusals from 7/1/24 to 7/9/24 for all medications except one. Records also revealed staff documentation regarding R1's refusals, increased behaviors, and staff's communication with R1's Case Manager. R1's Physician's Report showed that R1 could leave the facility unassisted and that R1 required medication management assistance.

During an unannounced facility visit, LPA directly observed the location of the centrally stored medications for residents. The medications were organized by resident name and stored properly, including refrigerated medications. LPA observed the medications to be in locked areas with access via keys that only staff held. LPA did not observe any medication in R1's room during the facility visit.

The investigation revealed that while the medication in question did come to be stored outside of the central location, facility staff took action right away to rectify the situation and notified the appropriate persons. The investigation revealed a conflict within the VA system for how medications were delivered to residents who were not supposed to have access to them. Consultation was done with the Licensee and R1's Case Manager to adjust the process for how medications are accepted at the facility, to include additional measures to prevent resident unsupervised access to prescriptions.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator Bessie Pascual, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

LIC9099 (FAS) - (06/04)

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