374603338-11-14-2024-08-AS-RCLK-DBJ9XQ-20241130224554

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603338
Report Date: NO Visit Data Available
Date Signed: 11/14/2024 03:59:32 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
and conducted by Evaluator Alyssa Ramirez

COMPLAINT CONTROL NUMBER: 08-AS-20240612153959

FACILITY NAME:	EASY LIVING @ MIRA MESA		FACILITY NUMBER:	374603338
ADMINISTRATOR:	CALCETA, MYRNA		FACILITY TYPE:	740
ADDRESS:	10136 ZAPATA AVENUE		TELEPHONE:	(858) 566-7233
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	6	CENSUS: 4	DATE:
		UNANNOUNCED	TIME BEGAN:
MET WITH:	Administrator Oliver Calcetas		TIME COMPLETED:

ALLEGATION(S):

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Staff treated resident roughly

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Administrator Oliver Calcetaand discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of records review, interviews with facility staff, clients and outside agency.

It was reported to CCL that staff treated resident roughly.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Robyn Clark	TELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Alyssa Ramirez	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE:

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE:

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-20240612153959

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: EASY LIVING @ MIRA MESA	FACILITY NUMBER: 374603338
	VISIT DATE: 11/14/2024

NARRATIVE

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Regarding the allegation, it was reported that resident (R1) stated that staff who gave a bath was “rough”. It was also reported that R1 said that facility staff was aggressive. Review of records revealed that R1 has a diagnosis of Senile Degeneration of the brain and Chronic Kidney Disease. Interviews with facility staff revealed that staff have never witnessed anyone handle residents in a rough manner. Facility staff reported that they do not bathe R1, and stated that home health staff from outside agency bathe R1. Interviews with R1 revealed that the “bath nurse is rough”, no additional information was provided. Interviews with outside sources revealed no concerns for staff handling residents in a rough manner. Outside sources reported being satisfied with care facility provides.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid. No deficiencies were cited today.

An exit interview was conducted with Administrator. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to NAME whose signature below verifies receipt of these rights.

SUPERVISOR'S NAME: Robyn Clark	TELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Alyssa Ramirez	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

LIC9099 (FAS) - (06/04)

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