374600907-6-9-2022-18-AS-JESL-CG8UG7-20220711153351

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600907
Report Date: 06/09/2022
Date Signed: 06/09/2022 03:44:20 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/03/2022 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220603122908

FACILITY NAME:	SILVERGATE FALLBROOK RETIREMENT RESIDENCE		FACILITY NUMBER:	374600907
ADMINISTRATOR:	PATRICIA A MARTINEZ		FACILITY TYPE:	740
ADDRESS:	420 ELBROOK DRIVE		TELEPHONE:	(760) 728-8880
CITY:	FALLBROOK	STATE: CA	ZIP CODE:	92028
CAPACITY:	145	CENSUS: 113	DATE:	06/09/2022
		UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Patricia Martinez, Executive Director		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Staff are not meeting resident's hygiene needs.
Staff handled resident in a rough manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George arrived at the facility unannounced to commence a complaint investigation for the allegations listed above. LPA met with Patricia Martinez, Executive Director and explained the purpose of the visit, and elements of the allegations. The investigation consisted of observation, interviews and record review.

Allegation: Staff are not meeting resident's hygiene needs
Resident #1 (R1) is receiving hospice services. Some of the services provided include hygiene (bathing, brushing teeth, clipping nails/toe nails and brushing hair). Interviews conducted revealed that R1 is currently transitioning and is sleeping most of the time. Interviews also revealed that staff were instructed by R1s responsible party not to give or provide a service such as bathing if R1 is agitated. There has also been some recent disagreements with R1s responsible party and other family members, where one has stated not to do provide a service or share information, but the others do not agree. The last salon documented salon service was on February 23, 2022. Additionally, It was reported that R1s toe nails had not been cut. R1 was observed to have their big toe grown out and it had begun to lift and was torn off.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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 18-AS-20220603122908

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SILVERGATE FALLBROOK RETIREMENT RESIDENCE	FACILITY NUMBER: 374600907
	VISIT DATE: 06/09/2022

NARRATIVE

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Per Executive Director Patricia Martinez, Due to R1s diabetes diagnosis the clipping of nails and toe nails are to be provided by hospice. Per documentation reviewed on 5/18/22, R1s right big toe nail was removed, and other toe nails were trimmed. Additionally, the facility has a mobile podiatrist that comes to the facility, residents can schedule and sign up for appointments. Private pay residents go as they please and if the resident has medicare then every 60 days they can see the podiatrist. Additional interviews conducted revealed that R1s identified responsible party is believed to have been informed about the condition of R1s toe nails and did nothing about it. Therefore the allegation of Staff are not meeting resident's hygiene needs is UNFOUNDED.

Allegation: Staff handled resident in a rough manner.

LPA was unable to interview R1 due to being asleep throughout LPAs visit, as they are transitioning. LPA conducted interviews which revealed that there is not a concern about how the facility staff is treating or handling R1, the issue with R1s responsible party giving conflicting messages and not following through in regards to the care of R1. Based on the reports of not being with the facility it is with R1s responsible party. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted and a copy of this report was provided to Patricia Martinez, Executive Director.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC9099 (FAS) - (06/04)

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