306005351-7-7-2022-22-AS-AORZ-CGAMNR-20220713094555

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005351
Report Date: 07/07/2022
Date Signed: 07/07/2022 03:14:24 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2022 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20220504153811

FACILITY NAME:	LA VIDA AT MISSION VIEJO		FACILITY NUMBER:	306005351
ADMINISTRATOR:	JUSTINE ORTIZ		FACILITY TYPE:	740
ADDRESS:	27783 CENTER DRIVE		TELEPHONE:	(949) 364-6210
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92692
CAPACITY:	150	CENSUS: 102	DATE:	07/07/2022
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Justine Ortiz		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff member was verbally abusive to residents in care.
Staff member handled residents in a rough manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility by Executive Director Justine Ortiz and explained the reason for the visit.
During the course of the investigation, LPA toured the facility and interviewed staff and witnesses. Regarding the allegation that staff member was verbally abusive to residents in care and staff member handled residents in a rough manner, the investigation revealed the following: On 04/02/2022, it was reported to Enliven Director that Staff 1 (S1) had been physically and verbally rough with residents in the memory care unit. S1 was taken off the schedule immediately pending an investigation. Residents were assessed to have no injuries. S1 resigned during the investigation process. Five out of six staff interviewed denied ever seeing S1 be physically or verbally rough with a resident. All staff interviewed indicated S1 has a loud voice and strong personality. Two out of two residents interviewed state satisfaction with the facility staff. LPA attempted to interview five residents in the memory care unit but was unsuccessful due to resident's Dementia diagnosis. Facility management indicate no prior complaints regarding S1's demeanor. CONT ON LIC 9099 DATED 07/07/2022

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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 22-AS-20220504153811

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LA VIDA AT MISSION VIEJO	FACILITY NUMBER: 306005351
	VISIT DATE: 07/07/2022

NARRATIVE

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Resident 1's (R1) family indicates dissatisfaction with services provided by the facility but denies being an eyewitness to any abusive behavior by S1. Therefore, the allegations are deemed unsubstantiated, meaning 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 Administrator and a copy of this report was provided to facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

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