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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604323
Report Date: 06/19/2024
Date Signed: 06/19/2024 03:49:23 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
05/02/2024 and conducted by Evaluator Renita Hall
COMPLAINT CONTROL NUMBER: 08-AS-20240502153636
FACILITY NAME:SILVERGATE RANCHO BERNARDOFACILITY NUMBER:
374604323
ADMINISTRATOR:BRAKEVILLE, SONDRAFACILITY TYPE:
740
ADDRESS:16061 AVENIDA VENUSTOTELEPHONE:
(858) 451-1100
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY:285CENSUS: 285DATE:
06/19/2024
UNANNOUNCEDTIME BEGAN:
03:38 PM
MET WITH:Sondra Brakeville, AdministratorTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Licensee did not ensure that a skilled professional was administering a resident's oxygen as prescribed
Licensee did not ensure that a resident's oxygen equipment was operable
Licensee does not ensure that a resident's dietary needs are being met
Licensee is not adhering to the admission's agreement
Licensee does not ensure that residents are provided individual privacy in the shower area
Licensee does not maintain facility at a comfortable temperature for resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced visit to deliver findings regarding the above-mentioned allegations LPA was allowed entry by Sondra Brakeville, Administrator. LPA identified herself and disclosed the purpose of the visit and elements of the findings with the Administrator.

On May 2, 2024, the Department received a complaint for the following allegations: Licensee did not ensure that a skilled professional was administering a resident's oxygen as prescribed, Licensee did not ensure that a resident's oxygen equipment was operable, Licensee did not ensure that a resident's dietary needs are being met, Licensee is not adhering to the admission's agreement, Licensee does not ensure that residents are provided individual privacy in the shower area, Licensee does not maintain facility at a comfortable temperature for resident. The investigation consisted of tour of the facility, interviews, review of records.

Continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 08-AS-20240502153636
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: SILVERGATE RANCHO BERNARDO
FACILITY NUMBER: 374604323
VISIT DATE: 06/19/2024
NARRATIVE
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On May 6, 2024, staff interviewed all stated that Resident 1 (R1) oxygen was being prescribed, R1's oxygen was initially prescribed as needed per the PRN then later became necessary to wear an oxygen mask at night to maintain an oxygen level above 90%. However, R1 would take the oxygen mask off at night which would cause levels to drop below 90%. R1 would need to have encouragement to keep the oxygen mask on but would refuse. The outside source also stated that R1 would not keep the oxygen mask on. The oxygen equipment was maintained at the request of the family but was not the responsibility of the facility. Since the oxygen was no longer prescribed as needed, and to be used nightly there was an additional charge by the facility. RP stated that they refused to pay for the additional charge.

Staff and outside source stated that the resident's dietary needs were being met. The outside source and staff stated that the resident eats 3 times per day and takes Ensure as a supplement. RP did not state how the facility was not adhering to the admissions agreement and no examples were given. Staff interviewed stated that R1 was given privacy and staff were there to assist. The Maintenance Manager was interviewed and stated that the controls in the individual bedrooms control 3 to 4 bedrooms. If the temperature is set to a cooler temperature it affects all the rooms connected and vice versa for warmer temperatures. The residents would need to agree if they wanted their rooms to be cooler or warmer.

Based on the investigation findings, the allegations made against the facility are unsubstantiated. A finding that is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with Sondra Brakeville, Administrator. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Administrator and her signature on this report confirms receipt of the Licensee Rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2