374604734-8-1-2024-08-AS-SJAB-D7RLZ5-20240802091119

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604734
Report Date: 08/01/2024
Date Signed: 08/01/2024 04:30:55 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
04/10/2024 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20240410114321

FACILITY NAME:	CHANGING OPTIONS		FACILITY NUMBER:	374604734
ADMINISTRATOR:	MELCHER, JENNIFER		FACILITY TYPE:	735
ADDRESS:	500 3RD STREET		TELEPHONE:	(714) 224-0826
CITY:	RAMONA	STATE: CA	ZIP CODE:	92065
CAPACITY:	14	CENSUS: 14	DATE:	08/01/2024
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Serita Polinaire, Clinical Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility is inadequately staffed to manage client behavior
Facility is not addressing pest infestation

INVESTIGATION FINDINGS:

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On August 1, 2024, Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced visit to the facility to deliver these amended complaint investigation findings for the above allegations. After introducing and identifying himself, LPA met Ms. Polinaire to discuss the findings.

On April 10, 2024, the Department received a complaint with allegation that facility is inadequately staffed to manage Client 2’s (C2) behavior. The Department’s investigation consisted of observations, review of facility records, interviews with client, staff, and other pertinent individuals.

A review of C2’s records, the Physician’s Report dated January 9, 2024, revealed C2 had a bowel and bladder impairment. Based on Needs and Services Plan dated February 19, 2024, C2 had a diagnosis where increased urinary urgency and frequency was observed. According to staff interviews, C2 urinates and defecates in inappropriate places, including common areas of the facility. It was alleged that the facility was inadequately staffed to manage this behavior. C2’s care plan was reviewed and found to include a generic plan to address this behavior. Interviews revealed that following the behavior, staff

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 08-AS-20240410114321

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: CHANGING OPTIONS	FACILITY NUMBER: 374604734
	VISIT DATE: 08/01/2024

NARRATIVE

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would clean affected area(s). Staff interviews revealed arrangement for medication changes, provided incontinent supplies and staff offered assistance. Although the care plan documented C2’s behavior, it did not include specific interventions to be used to address the behavior. LPA’s observations revealed no foul odors other than C2’s room. The Department interviewed C2 and it corroborated C2 is provided incontinent supplies and did not disclose any concerns of the services provided by the facility. Interviews with outside sources revealed no concerns about the services provided by the facility and there is belief the staff are meeting C2’s needs. Interview with facility management schedule 2 caregivers every shift to meet the needs of the residents. The investigation did not corroborate the facility is inadequately staffed to manage C2 behavior. Based on evidence obtained, the preponderance of evidence standard was not met, therefore the allegation is determined to be unsubstantiated.

On April 10, 2024, the Department received a complaint with an allegation that facility is not addressing a pest infestation. The Department’s investigation consisted of observations, review of relevant records, and interviews with client, staff, and other pertinent individuals.

LPA conducted tour and observed freezers, refrigerators, pantries, under cabinets and appliances and did not observe any evidence of pests. A review of Invoice and Service Reports revealed a pest control company provided the following services: on January 16, 2024, serviced for rats and spiders on side yard and outside perimeter; on February 14, 2024, serviced for stickbugs on outside perimeter; on March 19, 2024, serviced for spiders on outside perimeter; on April 17, 2024, serviced for spiders on outside perimeter; on May 15, 2024 serviced for ants, cockroaches, earwigs and spiders on outside perimeter and walkway edges. Pest control documents did not support the interior of the facility was serviced.

Staff interviews were inconsistent with how prevalent the pest infestation was. Responses ranged from staff indicating they had never seen any pests or rodents to others indicating they had seen a mouse every other week between November and February 2024. Staff interview revealed pest control placed baited poison traps outside of the facility. Facility staff discovered an entry point and sealed the opening. Traps were then laid to catch mice and the one staff indicated they had not seen a mouse since February of 2024. Other staff interviews did not reveal a timeline of the last time a pest or rodent was seen inside the facility.
Client interviews did not corroborate there was a pest infestation. Interviews with pertinent individuals revealed pest control serviced the facility on a month-to-month basis. The service area covered the inner and outer perimeter. The interview with the pertinent individual revealed that because it would require the

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 08-AS-20240410114321

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: CHANGING OPTIONS	FACILITY NUMBER: 374604734
	VISIT DATE: 08/01/2024

NARRATIVE

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facility to evacuate, the inner area was not sprayed. In addition, an interview with pest control revealed that if the facility had advised them of mice in the building, they would have placed bait stations in the facility and advised to fill access point.

Based on evidence obtained, the preponderance of evidence standard was not met, therefore the allegation is determined to be unsubstantiated. Ms. Polinaire and a copy of this report was provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024

LIC9099 (FAS) - (06/04)

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