374601228-1-10-2024-08-AS-LTEZ-CZQRKS-20240122120601

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601228
Report Date: 01/10/2024
Date Signed: 01/10/2024 02:51:23 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/16/2021 and conducted by Evaluator Becky Kennedy

COMPLAINT CONTROL NUMBER: 08-AS-20210416145607

FACILITY NAME:	ALTA VISTA MANOR		FACILITY NUMBER:	374601228
ADMINISTRATOR:	ANNA WILSON		FACILITY TYPE:	740
ADDRESS:	625 MARAZON LANE		TELEPHONE:	(760) 522-2008
CITY:	VISTA	STATE: CA	ZIP CODE:	92083
CAPACITY:	15	CENSUS: 9	DATE:	01/10/2024
		UNANNOUNCED	TIME BEGAN:	02:19 PM
MET WITH:	Anna Wilson		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff not meeting residents incontinence needs
Facility staff are not changing a residents bedding
Facility staff failed to keep the facility free of odors

INVESTIGATION FINDINGS:

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

Licensing Program Analyst Becky Kennedy concluded the investigation which began on 4/22/2021. LPA Kennedy made an unannounced visit to the above facility today and met with Administrator, Anna Wilson. LPA advised them of the reason for today's visit and delivered the investigation findings on the above allegations.

It was alleged that Resident 1’s (R1) room smelled of urine, the bed sheets had feces, and that R1’s brief had not been changed and appeared very saturated.

The investigation into the above allegations consisted of interviews with staff, outside sources, a review of records, and virtual tour of the interior and exterior of the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Becky Kennedy	TELEPHONE: (619) 672-5843
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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-20210416145607

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: ALTA VISTA MANOR	FACILITY NUMBER: 374601228
	VISIT DATE: 01/10/2024

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

The investigation revealed that the facility had thirteen residents in care, nine of whom were incontinent and required full care with their toileting needs. The facility has three care staff on duty during waking hours and two during the night. Interviews revealed that care staff check on each resident every two hours including overnight, and provide care as needed. The facility training material regarding incontinence care is thorough and includes cleanliness of laundry and furniture as well as getting rid of lingering odors.

Per mayoclinic.org “skin that is constantly in contact with urine may get irritated or sore and can break down. This happens with severe incontinence if you don't take precautions, such as using moisture barriers or incontinence pads.” The investigation revealed that R1 did not have any skin breakdown.

An outside source was in the facility four days after the above concerns were alleged and no concerns were identified by the outside source during that visit.

Interviews and documentation did not provide enough evidence to prove a violation occurred therefore these allegations are found to be unsubstantiated. An exit interview was conducted and a copy of this report, and appeal rights were given to Anna Wilson.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Becky Kennedy	TELEPHONE: (619) 672-5843
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2