374600675-12-13-2024-08-AS-SJAB-DC5UU7-20241220145305

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600675
Report Date: 12/13/2024
Date Signed: 12/13/2024 03:31:28 PM

Unfounded

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
12/11/2024 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20241211085525

FACILITY NAME:	VI AT LA JOLLA VILLAGE		FACILITY NUMBER:	374600675
ADMINISTRATOR:	BOUDREAU, STEPHANIE		FACILITY TYPE:	741
ADDRESS:	8515 COSTA VERDE BLVD		TELEPHONE:	(858) 646-7700
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92122
CAPACITY:	783	CENSUS: 515	DATE:	12/13/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Executive Director, Stephanie Boudreau		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not meet the needs of residents in care
Staff did not accord dignity to residents in care
Staff did not maintain the facility in good sanitary condition

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to open a complaint investigation. While at the facility LPA investigated and delivered findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Executive Director, Stephanie Boudreau. LPA stated the purpose of the visit and reviewed and delivered the findings of the complaint with Boudreau.

The Department’s investigation consisted of interviews with staff and a detailed review of relevant records pertinent to this investigation. On December 11, 2024, it was alleged that the staff did not meet the needs of residents in care, staff did not accord dignity to residents in care and staff did not maintain the facility in good sanitary condition.

Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained from staff interviews and records review, we have found that the complaint was unfounded. (continue at LIC9099C)

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

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-20241211085525

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: VI AT LA JOLLA VILLAGE	FACILITY NUMBER: 374600675
	VISIT DATE: 12/13/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(continue from LIC9099)

An unfounded determination means that the allegation was false, could not have happened, and/or is without a reasonable basis. The allegations were not pertinent to this licensed facility. The Department will be cross-reporting this complaint to the appropriate agency for follow-up.

The report was discussed, and an exit interview was conducted with Executive Director, Boudreau, to whom a copy of this report along with Licensee/Appeal Rights (LIC9058 03/22) was provided at the conclusion of the visit. The signature below confirms the receipt of these documents.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2