361880835-7-19-2022-18-AS-NBRN-CGVVDS-20220801162111

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880835
Report Date: 07/19/2022
Date Signed: 07/19/2022 11:43:39 AM

Unsubstantiated

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/10/2021 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211210110506

FACILITY NAME:	VISTA BLUE MOUNTAIN		FACILITY NUMBER:	361880835
ADMINISTRATOR:	KELLEY LARA		FACILITY TYPE:	740
ADDRESS:	22325 BARTON ROAD		TELEPHONE:	(909) 420-0153
CITY:	GRAND TERRACE	STATE: CA	ZIP CODE:	92313
CAPACITY:	150	CENSUS: 70	DATE:	07/19/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Tara Taylor		TIME COMPLETED:	11:46 AM

ALLEGATION(S):

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Staff are not adequately assisting resident with medications
Staff do not assist the resident with managed incontinence
Staff do not respond to call button in a timely manner
Staff did not treat the resident with dignity

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to this facility for the purpose of delivering findings for the above allegations. LPA Bueno met with resident care director Tara Taylor, who was informed the purpose of today’s visit. The investigation consisted of interviews and records review relative to the allegations. Below is a summary of the findings.

Allegation 1: Staff are not adequately assisting resident with medications. Review of Resident 1 (R1) physician’s report and interviews reveal that R1 has a history of alcohol abuse. Records show that staff have been giving R1 their daily medication. Staff interviews and records showed that in November through December 2021 R1 would regularly refuse their medication or not wake up to take them. Staff 1 (S1) and Staff 3 (S3) stated that R1 would leave the facility and return intoxicated. S1 and S3 stated they would not give R1 their medication when R1 are intoxicated due to the the effects of mixing alcohol and medication. For these reasons, the allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

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-20211210110506

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
, CA 92507

FACILITY NAME: VISTA BLUE MOUNTAIN	FACILITY NUMBER: 361880835
	VISIT DATE: 07/19/2022

NARRATIVE

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Allegation 2: Staff do not assist the resident with managed incontinence. LPA’s investigation did not discover any evidence that staff was not meeting R1’s incontinence needs. R1’s physician’s report and service plan states that R1 did not have any incontinence needs. Interviews revealed that R1 had a slight incontinence issue related to a change in medication. Interviews also reveal that the facility addressed this concern with R1’s responsible party and R1 was temporarily using adult briefs until R1 adjusted to their medication. This allegation is therefore UNSUBSTANTIATED.

Allegation 3: Staff do not respond to call button in a timely manner. Review of the emergency call system revealed that R1 calls for assistance between one to 14 times daily, averaging to about 5 calls per day. The call system records also reveal that the calls have been answered between 2 seconds and 32 minutes. Further review of the day the response time was the longest, November 28, 2021, show that R1 called for staff 9 times. The response times (in minutes) on this day were as follows: 6, 13, 32, 4, 1, 48 seconds, 6, 3, and 9. This allegation is therefore UNSUBSTANTIATED.

Allegation 4: Staff did not treat the resident with dignity. Interviews and records show that R1 had a history of alcohol abuse and was ambulatory. Staff 2 (S2) stated that R1 becomes aggressive and combative in their intoxication. Staff and family member interviews revealed that staff assisted R1 in some hygiene and toileting assistance even if this was not in their needs and services plan. For these reasons, this allegation is UNSUBSTANTIATED.

A finding of unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted with Ms. Taylor and telephonically with administrator Niare Feaster and a copy of this report was provided to Ms. Taylor.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

LIC9099 (FAS) - (06/04)

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