374600675-1-23-2023-08-AS-DPOL-CNLVGJ-20230131152537

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600675
Report Date: 01/23/2023
Date Signed: 01/23/2023 05:25:18 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/22/2022 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20221122105807

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: 525	DATE:	01/23/2023
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Administrator, Stephanie Boudreau		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility did not keep indoor passageways free from obstruction

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 Administrator, Stephanie Boudreau to whom she identified herself and discussed the purpose of the visit.

The Department investigated the above listed complaint allegation. The investigation consisted of an inspection of the facility, multiple interviews with staff and outside sources, and records review, including Fire Clearance Inspection Report.

On 11/22/2022, Community Care Licensing (CCL) received a complaint alleging the facility did not keep indoor passageways free from obstruction. Specifically, it was alleged that the South Tower hallways of the facility was too narrow posing a safety risk for residents in care. Per the Inspection Division with the City of San Diego the passageways were built to the approved plans and comply with the Building Codes. In addition, Fire Clearance Inspection conducted on January 10, 2023, indicated no violation of Title 19 of the California Fire Code. (continue on LIC 9099C)

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

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 08-AS-20221122105807

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VI AT LA JOLLA VILLAGE	FACILITY NUMBER: 374600675
	VISIT DATE: 01/23/2023

NARRATIVE

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continue from LIC9099

Based on the results of the investigation, which consisted of observations, interviews with key staff and outside sources, and review of pertinent facility and outside records there was no evidence found to support this allegation. The Department has found that the complaint allegation was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with Executive Director, Stephanie Boudreau, to whom a copy of this report, and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

LIC9099 (FAS) - (06/04)

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