374600675-3-3-2025-08-AS-SJAB-DEWNNZ-20250319103734

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600675
Report Date: 02/28/2025
Date Signed: 03/03/2025 01:48:16 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
02/11/2025 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20250211003115

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: 524	DATE:	02/28/2025
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Executive Director, Stephanie Boudreau		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff threatened a resident with eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA was greeted by Executive Director Stephanie Boudreau, to whom she identified herself and explained the purpose of the visit.

The Department investigated the above-listed complaint allegation. The investigation included a facility tour, multiple interviews, and a detailed review of relevant records.

On February 11, 2025, Community Care Licensing (CCL) received a complaint alleging that facility staff threatened Resident 1 (R1) with eviction, [A Confidential Names List (LIC 811) was provided to staff to identify the resident.]

(Continue at LIC9099C)
****This is an amended LIC9099****

Unsubstantiated

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: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

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 3

Control Number 08-AS-20250211003115

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: 02/28/2025

NARRATIVE

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continue from LIC9099

The complaint specifically alleged that staff repeatedly threatened R1, stating that if they continued to complain about the cold temperature in their room, they would be transferred to a skilled nursing facility and their apartment would be sold. However, interviews with outside sources did not provide details regarding when or how these threats occurred. Additionally, outside sources stated that they were unaware of R1 being verbally or informally served with an eviction notice.

During an interview conducted on February 10, 2025, R1 did not express any concerns regarding eviction. R1 stated that on January 18, 2025, they experienced an unwitnessed fall in their apartment, which resulted in a traumatic left subdural hematoma. On January 25, 2025, R1 was transferred to a skilled nursing facility for continued treatment and recovery. On February 7, 2025, R1 was discharged back to their independent living apartment under 24/7 care and supervision due to a change in condition.

On February 12, 2025, a care plan meeting was held with R1 to discuss their current needs. It was determined that R1 required assistance with all activities of daily living and was considered a high fall risk due to their recent fall, poor balance, general weakness, and low blood pressure. During this meeting, R1 agreed with the care plan and acknowledged the need for assistance to continue residing in their independent living apartment. R1 also stated that the care plan included physical, occupational, and speech therapies to help regain independence.

Multiple interviews with key staff and outside sources consistently denied the allegation, stating they had never witnessed or heard of any staff member threatening R1 with eviction. On the contrary, interviewees indicated that the staff’s primary focus was to develop and implement a comprehensive service care plan to ensure R1’s health and safety while remaining in their independent living apartment were met.

Based on the results of the investigation, which consisted of observations, interviews with key staff and outside sources, and a review of pertinent resident records there was insufficient evidence to support the allegation that staff threatened R1 with eviction.

(Continue at LIC9099C)

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20250211003115

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: 02/28/2025

NARRATIVE

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(continue from LIC9099C)

Therefore, this allegation is unsubstantiated. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence that the alleged violation occurred.

An exit interview was conducted with Executive Director Stephanie Boudreau, who was provided with a copy of this report, the Confidential Names List (LIC 811), and the Licensee Appeal Rights (9058 03/22) at the conclusion of the visit.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

LIC9099 (FAS) - (06/04)

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