La Jolla Casa Fiesta

Allegation investigated: Licensee made false claims Licensee did not ensure the food provided was of good quality Licensee did not ensure the facility was clean Administrator not on the premises a sufficient number of hours

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 Tiffany Lynch, House Manager. On 11/29/22 it was alleged that the Licensee made false claims, did not ensure the food provided was of good quality, did not ensure the facility was clean, and the Administrator was not on the premises a sufficient number of hours. The Department’s investigation consisted of two unannounced facility tours, review of facility and outside source records, interviews with facility staff, residents, outside sources, and LPA direct observations. Regarding the first allegation, "Licensee made false claims", it was alleged that the facility's online advertisements were misleading regarding furniture, food service, and activities/therapies provided. On two unannounced facility visits LPA observed the items and programming in question. (Continued on LIC9099-C) Unsubstantiated (Continued from LIC9099) LPA observed the facility furniture to be the same and/or similar in nature to the furniture photos and videos on the website. Records review of food menus and activities showed that residents are being offered variety and quality in both categories and within the requirements of Title 22 regulations. Staff interview revealed that while residents are offered the calendared activities, they will decline to participate at times or ask for a different activity. Records review and outside sources interviewed confirmed that staff assist residents with required therapies. Regarding the second allegation, "Licensee did not ensure the food provided was of good quality", it was alleged that the Licensee did not provide a variety of protein and offered low amounts of vegetables and fruit. Staff interview revealed that residents are provided nutritional meals 3 times per day, with snacks. Interview revealed that at times the food offerings are adjusted based on what is available at the facility, but the meal service is not disrupted. Residents can request a different food option if they are not interested in what is offered. Outside source interview revealed no concerns regarding food service at the facility, and that residents enjoy the meals. Records review of the food menu showed the food options to meet the dietary requirements of Title 22. Regarding the third allegation, "Licensee did not ensure the facility was clean", Staff interview revealed that staff are responsible for daily cleaning tasks during their shifts. Cleaning tasks include sweeping and mopping, cleaning bathrooms, sanitizing counters and tables, and resident laundry. Deep cleaning tasks such as cleaning window blinds are completed every 1-2 months. Outside source interview revealed that the facility is clean and organized. Outside sources did not have concerns regarding the cleanliness of the facility. On two unannounced facility visits LPA directly observed the facility to be clean, without obstructions or hazards, and no odors that would indicate unsanitary conditions. (Continued on LIC9099-C) (Continued from LIC9099-C) Regarding the fourth allegation, "Administrator not on the premises a sufficient number of hours", Staff interview revealed that the Administrator is on the premises between 15-30 minutes each week. Title 22 87405(a) states, "…The administrator ... shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration". Staff and outside interviews revealed the facility House Manager to be the designated staff qualified to complete the necessary administration tasks at the facility. Interview revealed the House Manager to be present at the facility full time and also available and responsive via phone while not at the facility. On two unannounced facility visits LPA directly observed the House Manager present at the facility; House Manager was observed to have intimate knowledge of the facility, resident care, and staff management situations. During these facility visits the House Manager answered all questions regarding how the facility was managed and produced all requested paperwork. 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 Tiffany Lynch, House Manager, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Aug 2, 2023 · control 08-AS-20221129155406

Allegation investigated: Licensee did not provide refund

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to initiate a complaint investigation regarding the above-mentioned allegation. LPA identified herself and met with Tiffany Lynch, House Manager deliver to discuss the purpose of the visit and elements of the complaint. During the visit LPA collected facility records, conducted a tour of the facility and interviews. It was alleged that licensee did not provide refund. Interviews revealed that Resident 1 (R1)s Responsible Party (RP) gave a 30 day notice on December. 26, 2022 and moved the resident out on January. 23, 2023. Interviews revealed that the Responsible Party (RP) returned on January. 24, 2023 to pick up the remainder of R1's belongings. Interviews revealed R1's belongings were moved to the garage and the room was being painted. Substantiated Interviews reveled that the RP had already made payment through January. 31, 2023. Interviews with RP revealed they believed they still had access to the room and R1's belongings up until January. 31, 2023 but instead, the items that were left behind were moved to the garage. Documentation provided to the department shows an email to the licensee requesting a refund for the last few days of the month, January. 25, 2023 through - January. 31, 2023. Interviews revealed that the RP has not received a refund as of the date the investigation was opened on March. 8, 2023. The allegation is substantiated and is cited on the LIC 9099D page. An exit interview was conducted with Tiffany Lynch, House Manager. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided and her signature on this report confirms receipt of the Licensee Rights.the state’s words, verbatim · CDSS document, Apr 26, 2023 · control 08-AS-20230227143122

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Apr 28, 2023

(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by: On 01/23/23 R1 moved out and had paid rent through 01/31/2023. No refund was provided to 1out of 6 residents within the 15 day window. This poses a potential safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 26, 2023

Plan of correction: Licensee will provide R1s RP a refund for days 1/25/2023 -1/31/2023 by POC due date of 04/28/2023. Copy of check must be provided to CCL before or on POC due date of 04/28/2023

Allegation investigated: Resident's medical documentation is not maintained properly.

Licensing Program Analyst (LPA) Sabel Martinez, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. The LPA was greeted by House Manager, Tiffany Lynch, identified himself, and disclosed the purpose of the visit. The Department’s investigation consisted of review of records, and interviews with internal and external sources. It was alleged a resident's medical documentation was not maintained properly. An external source reported a resident’s Long-Term Care insurance documentation was not filled out properly resulting in late insurance compensation. Interviews with this sources, additional outside sources, and internal sources confirmed, that while some of the documentation may have been submitted past the due date, insurance benefits were still received by the residents. (See attached LIC 812) Unfounded Interviews and a review of California Code of Regulations, Title 22, and Health and Safety Code, corroborated there was not an existing regulation requiring the Licensee to submit Long Term Care Insurance documentation. Based on the evidence obtained during the complaint investigation, the allegation above is found to be UNFOUNDED, meaning that the allegations is false, could not have happened, or is without a reasonable basis. No deficiencies were cited on today’s date. An exit interview was conducted with House Manager, Tiffany Lynch. A copy of this report and Licensee's Rights (LIC 9058) were provided to Administrator, Jennifer Fernandez, via electronic mail. An electronic mail read receipt confirms these documents were received by the administrator.the state’s words, verbatim · CDSS document, Nov 30, 2022 · control 08-AS-20220523145224

Allegation investigated: Licensee did not provide the resident an admission agreement Licensee did not provide written notice of rate increase

Licensing Program Analyst (LPA) Sabel Martinez, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. The LPA was greeted by House Manager, Tiffany Lynch, identified himself, and disclosed the purpose of the visit. The Department’s investigation consisted of review of records, and interviews with internal and external sources. It was alleged the licensee did not provide the residents an admission agreement. Interviews with external sources revealed the facility ownership changed, and at that time, multiple residents did not receive an admission agreement from the new licensee. An interview with an internal source confirmed the resident’s documents obtained at the facility were the most updated records. Review of these records corroborated multiple admission agreements were not from the current facility, but instead the admission agreements from the previous Licensee. Substantiated It was alleged the licensee did not provide written notice of rate increase. Interviews with external sources reported the licensee did not provide proper written notice of rate increase. Interviews with additional external sources revealed the licensee did not provided proper written notices. Documents received by internal and external sources corroborated the licensee did not submit proper rate increase notices. Based on the evidence obtained during the complaint investigation, the preponderance of evidence standard was met. Therefore, the allegations of licensee did not provide the residents an admission agreement and licensee did not provide written notice of rate increase, were Substantiated and cited in the LIC 9099D. A Plan Of Correction was jointly formulated with the House Manager, Tiffany Lynch. An exit interview was conducted with House Manager, Tiffany Lynch, to whom a copy this report, LIC 9099D, and Licensee's Rights (LIC 9058) were provided to.the state’s words, verbatim · CDSS document, Nov 22, 2022 · control 08-AS-20221003153544

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(a) · Plan of correction due date: Nov 21, 2022

87507 Admission Agreement (a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. This requirement is not met as evidence by: Based on interviews, and records review, the licensee did not complete individual written admission agreements which posed a potential health, safety, and personal rights risk to 2 of 6 persons in care.the state’s words, verbatim · CDSS document, Nov 22, 2022

Plan of correction: House Manager agreed to complete admission agreements for residents that did not receive an agreement from the new licensee. Proof will be submitted to the LPA by 12/15/2022.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655 · Plan of correction due date: Nov 21, 2022

1569.655 (a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. This subdivision shall not apply to optional services that are provided by individuals, professionals, or organizations under a separate fee-for-service arrangement with residents. This requirement is not met as evidenced by: Based on interviews and record review, the Licensee did not provide written notice with a general description of the additional costs, which posed a potential health, safety, and personal rights risk to 2 of 6 residents in care.the state’s words, verbatim · CDSS document, Nov 22, 2022

Plan of correction: Licensee submitted proof of written rate increase documentation to the LPA. POC was cleared on today's date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced Required 1 - Year inspection. The LPA was greeted by House Manager, Tiffany Lynch, identified himself, and discussed the purpose of the visit. During today's inspection, the LPA observed the following: No pools or bodies of water were observed. Exterior and interior passageways were free from obstructions. Toxins, cleaning supplies, and chemicals were locked and inaccessible to residents at the time of the visit. Each resident had clean and sufficient bed linens, towels, and washcloths. All of the residents’ rooms were equipped with the required furnishings. Residents’ bathrooms were observed to be sanitary and operational. The facility was stocked with a 2-day supply of perishable and a 7-day supply of nonperishable food items. Medications were stored in a locked cabinet and were labeled and maintained in compliance with label instructions. In accordance with the Department’s Infection Control program, the LPA provided technical assistance and observed and evaluated the facility's implementation of infection control practices. The LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff and visitors; a sign-in policy enacted for all visitors; signs posted at facility entrance with the facility’s visitor policy, and signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; and emergency agencies’ contact information posted in a location visible to staff and resident. Based on observations, the facility is in compliance with and has implemented infection control practices. No deficiencies were observed during today's visit. An exit interview was conducted with House Manager, Tiffany Lynch, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided to.the state’s words, verbatim · CDSS document, Jun 1, 2022

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Laarni Santiago conducted an announced Pre-licensing and Component IIl visit to ensure compliance with California Code of Regulations, Title 22, Division 6 and the Health and Safety Code. LPA Santiago identified herself to Applicant, Jennifer Fernandez and explained the purpose of the visit. The fire inspection was completed on February 25, 2021 by the San Diego Fire Department. Facility was cleared for six residents ages 60 and above, five (5) that may be non-ambulatory, and one (1) of which may be bedridden in dedicated bedroom only. Hospice Waiver approved for 2 residents. During today's visit LPA Santiago, accompanied by Applicant, Jennifer Fernandez, conducted a tour of the facility. According to Applicant, there will be no firearms or ammunition stored on site. No pools or bodies of water were observed. Indoor and outdoor passageways are free from obstructions. All window screens are clean and in good repair. Hallways are well-lit and night lights are available in the hallways. Fire smoke alarms, and carbon monoxide detectors were all observed and operational. There is a bed for each resident's bedroom, equipped with padded covered mattresses, and pillows, observed clean and in good repair. There is sufficient closet and drawer space for resident belongings. Each resident bedroom is furnished with a chair, lamp, and a night stand. Resident bathrooms are also in good repair; equipped with handrails and showers were equipped with non-skid shower mats. The facility maintains a sufficient supply of clean linens, sheets, bedspreads, blankets, pillowcases, mattress covers, hand towels, and washcloths. LPA Santiago observed a seven-day supply of non-perishable foods and 2 day supply of perishables. The facility kitchen also maintains sufficient amounts of clean utensils, and equipment for proper storage of food items, and locked storage for sharp items. LPA Santiago observed an area for confidential storage area for personnel and resident records, as well as a locked storage for residents' medications. There is a shaded outdoor activity space, a common room available for visitors, and appropriate activity supplies. LPA observed a first aid kit maintained at the facility. The facility has a locked storage area for disinfectants and cleaning supplies and other toxic chemicals. There is emergency lighting and supplies readily available for safety measures. The hot water temperature measured with in compliance (107 to 115 degrees F) in facility bathrooms. Applicant Fernandez's Administrator's Certification expires on July 29, 2021 Component III was conducted at the facility with applicant Fernandez. LPA Santiago reviewed continuing operational requirements, as well as record keeping and physical plant compliance. The applicant shall contact the Centralized Application Bureau (CAB) for completion of this pending facility application. Based on today's evaluation, the facility is in compliance with CCR, Title 22 and the Health and Safety Code. Final approval is forwarded to management pending review. Pre-licensing inspection is complete and the facility has no deficiencies. An exit interview was conducted, and a copy of this report, and Licensee's Rights (9058 01/16) will be sent to the Applicant's e-mail address. An electronic mail read receipt confirms delivery and receipt of these documents.the state’s words, verbatim · CDSS document, Jul 9, 2021

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Jennifer Fernandez, Gus Fernandez Interview Method: Telephone interview On 7/6/21, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jul 6, 2021