374603349-11-15-2022-08-AS-DPOL-CLP2CD-20221130161635

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603349
Report Date: 11/15/2022
Date Signed: 11/15/2022 01:30:22 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/30/2021 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20211230080924

FACILITY NAME:	VISTA VILLAGE CARE		FACILITY NUMBER:	374603349
ADMINISTRATOR:	SMILJA MILOSAVLJEVIC		FACILITY TYPE:	740
ADDRESS:	222 WASHINGTON STREET		TELEPHONE:	(760) 295-7258
CITY:	VISTA	STATE: CA	ZIP CODE:	92084
CAPACITY:	12	CENSUS: 10	DATE:	11/15/2022
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Miljana Vasic, Caregiver		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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- Unlawful eviction.
- Staff did not safeguard resident’s belongings.
- Resident mattress was in disrepair.
- Facility staff did not treat resident with respect.
- Staff did not ensure a comfortable temperature in the facility.
- Resident dietary needs were not met.
- Resident did not have access to a phone.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Silvia Mendoza, caregiver. LPA stated the purpose of the visit and reviewed the findings of the complaint with Miljana Vasic, caregiver.

The Department’s investigation consisted of interviews with staff and outside sources, records review of relevant documents pertinent to this investigation, and LPA observation of the facility grounds. On December 30, 2021, the San Diego Regional Office received numerous allegations. It was alleged that the facility unlawfully evicted a resident; staff did not safeguard a resident’s belongings; resident’s mattress was in disrepair; facility staff did not treat a resident with respect; staff did not ensure a comfortable temperature in the facility; resident’s dietary needs were not met; and a resident did not have access to a phone.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

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-20211230080924

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: VISTA VILLAGE CARE	FACILITY NUMBER: 374603349
	VISIT DATE: 11/15/2022

NARRATIVE

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On December 30, 2021, it was alleged that the facility gave a resident an unlawful eviction notice. A review of records confirmed the facility did have an eviction notice on file for a resident dated October 13, 2021. The lawful eviction notice was given to the resident due to non-payment of monthly fees. According to the notice, payments were due for the months of July 2021 – October 2021. On October 26, 2022, LPA observed the resident in question was still residing at the facility and was not evicted.

It was alleged the facility staff did not safeguard a resident’s belongings. Specifically, it was alleged that staff did not return the resident’s washed items. Interview with an outside source maintained the items, two hospital gowns, were accounted for. LPA observed and confirmed the whereabouts of both hospital gowns. One hospital gown was being worn and the second hospital gown was clean and folded in a clear plastic bag. Interviews with other outside sources confirmed laundry is cleaned by staff, and all items are returned and put away.

It was alleged a resident’s mattress was in disrepair. It was alleged that the mattress spring would poke a resident on the back resulting in resident leaning to one side. Interview with staff mentioned one resident purchased a new mattress; however, the facility kept the former mattress as it was still in good condition. The former mattress was stored in the facility’s shed. LPA observed the former mattress and it had no springs. The mattress was a memory foam mattress and was covered in a thick plastic bed covering.

It was alleged that staff did not treat a resident with respect. Interviews with other outside sources did not support the allegation that staff were disrespectful to residents in care. Outside sources said staff were patient with all residents, and residents expressed satisfaction with staff. Interview with additional outside sources confirmed that they had not heard of any staff person being disrespectful to any resident.

It was alleged that the facility did not maintain a comfortable temperature and the staff did not address the concern. Interviews with outside sources confirmed that the air conditioning (AC) unit was in disrepair for approximately two to three days while a repair person obtained the necessary parts to fix the unit. Outside sources mentioned staff opened residents’ windows, provided residents with fans and fluids to ensure they were hydrated. Interview with additional outside sources mentioned that there are residents who have differences in preferred temperature; staff adjusted the temperature according to the climate and offered residents a fan or a blanket. The licensee confirmed that the AC unit was temporarily in disrepair.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20211230080924

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: VISTA VILLAGE CARE	FACILITY NUMBER: 374603349
	VISIT DATE: 11/15/2022

NARRATIVE

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It was also alleged that a resident’s dietary needs were not met; specifically, that the facility provided too many sweet items to eat. Interview with other outside sources did not confirm the allegation. Outside sources said that residents ate well at the facility. If a resident did not want to eat what was served, residents had the option to request other food items. If residents preferred a different meal, staff were typically able to accommodate requests. Interview with a staff stated that they were aware that there was one resident who had a dietary restriction and the resident was able to eat menu items or other items requested. Review of records confirmed a resident to have a “controlled diet” of no added salt; however, there were no physician’s orders found that were based on medical necessity. According to residents and outside sources, the facility’s overall meals contained salad and vegetables and a variety of meats served daily. Outside sources did not confirm the meals were too salty or facility served too many sweets.

Lastly, it was alleged that a resident did not have access to a phone at the facility. Interviews with outside sources mentioned most residents have their own cell phones, but if any resident needed to use the facility telephone, they could request to use the telephone and staff would assist them. Interview with additional outside sources revealed there was one inoperable telephone at the facility, but there was a second phone that staff and residents had the ability to use. At times, when the phone was in use, residents would have to wait, but it was mostly available for residents’ use. According to an outside source, residents had not mentioned they had any issues or inconveniences with the telephone use at the facility. In review of records, it was determined that there had been no interruption in telephone service. On October 26, 2022, during facility visit, LPA heard the telephone ring multiple times and staff responded to each phone call.

Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff and outside sources interviews, records reviewed, and LPA observations there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be unsubstantiated.

The report was discussed, and an exit interview was conducted with Licensee Dobrila Milosavljevic. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) was provided to the Licensee. The Licensee’s signature below serves as confirmation the documents were received.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC9099 (FAS) - (06/04)

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