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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603520
Report Date: 08/15/2023
Date Signed: 08/15/2023 02:43:01 PM

Substantiated


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
03/14/2023 and conducted by Evaluator Esther Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230314083629
FACILITY NAME:VIBRANT LIVINGFACILITY NUMBER:
374603520
ADMINISTRATOR:NORRIS, JULIEFACILITY TYPE:
740
ADDRESS:5723 BOUNTY STREETTELEPHONE:
(619) 269-6915
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:6CENSUS: 5DATE:
08/15/2023
UNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Julie Norris, LicenseeTIME COMPLETED:
11:58 AM
ALLEGATION(S):
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Staff did not allow visitations to residents without prior notice.
Staff confiscated resident's personal items.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced complaint investigation visit to the facility in order to deliver findings on the above allegations. LPA was granted entry by Jessica Garibay, caregiver, after identifying herself. LPA discussed the purpose of the visit and the allegations mentioned above with Julie Norris, Licensee.

On March 14, 2023, it was alleged that staff did not allow visitations to residents without prior notice and staff confiscated resident's personal items. The Department’s investigation consisted of review of facility records, outside source records, and interviews of facility staff and outside sources.

Regarding visitation, Licensee stated that, during the period of January 2023 to March 2023, visitors were not required to give prior notice before visiting, except for one visitor due to the visitor causing a

[Continued on LiC9099-C, Page 1 of 2]
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Esther MillerTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
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 5
Control Number 08-AS-20230314083629
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: VIBRANT LIVING
FACILITY NUMBER: 374603520
VISIT DATE: 08/15/2023
NARRATIVE
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disturbance during their visits. An incident report, submitted to the Department on January 11, 2023, indicated that a staff member witnessed a visitor yelling at Resident 1 (R1) in front of other staff and residents. Licensee stated that being informed of the visit beforehand allowed staff to prepare the visiting area away from other residents to minimize any disturbance caused. Licensee stated that she did not try to prohibit R1’s right to visit with that visitor and did not feel that the interaction rose to the level of abuse. Based on staff interview statements and record reviews, the allegation that staff did not allow visits to residents without prior notice is found to be SUBSTANTIATED.

It was also alleged that staff confiscated R1’s personal items, specifically their phone. Licensee witnessed R1 using their personal cell phone to call an outside source (OS) incessantly. Due to this, and at the request of OS, Licensee temporarily took R1's phone and stored it away from R1. Licensee stated that the phone was to be given back at the request of OS. OS admitted to requesting the phone to be taken away due to R1 incessantly calling but did not know that Licensee would not return the phone unless OS requested it to be returned. Due to Licensee’s statement, the allegation that staff confiscated resident's personal items is found to be SUBSTANTIATED.

Based on the evidence obtained during the complaint investigation, the allegations are found to be SUBSTANTIATED, as there is a preponderance of evidence to show that the violation occurred. Pursuant to the California Code of Regulations, Title 22, Division 6, deficiency is being cited on the attached LIC9099D and a plan of correction was jointly developed with Licensee. An exit interview was conducted with Licensee; a copy of this report and Licensee's Rights (LIC9058) were provided.











[Continued from LIC9099, Page 2 of 2]
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Esther MillerTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20230314083629
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: VIBRANT LIVING
FACILITY NUMBER: 374603520
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
09/15/2023
Section Cited
CCR
87468.1(a)(11)
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PERSONAL RIGHTS OF RESIDENTS IN ALL FACILITIES: (a) Residents ... shall have all of the following personal rights: (11) To have their visitors ... permitted to visit ... without prior notice... This requirement is not met as evidenced by:
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Licensee will provide a signed log of in-service training regarding resident's personal rights.
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Based on interview and record review the licensee did not allow visitation without prior notice in 1 of 6 persons in care (R1) which poses a potential personal rights risk to persons in care.
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Deficiency Dismissed
Type B
09/15/2023
Section Cited
CCR
87468.1(a)(12)
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PERSONAL RIGHTS OF RESIDENTS IN ALL FACILITIES: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (12) ,... to keep and use their own personal possessions ... This requirement is not met as evidenced by:
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Licensee will provide a signed log of in-service training regarding resident's personal rights.
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Based on interview and record review the licensee did not allow resident to keep own personal possession in 1 of 6 persons in care (R1) which poses a potential personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Esther MillerTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
03/14/2023 and conducted by Evaluator Esther Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230314083629

FACILITY NAME:VIBRANT LIVINGFACILITY NUMBER:
374603520
ADMINISTRATOR:NORRIS, JULIEFACILITY TYPE:
740
ADDRESS:5723 BOUNTY STREETTELEPHONE:
(619) 269-6915
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:6CENSUS: 5DATE:
08/15/2023
UNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Julie Norris, LicenseeTIME COMPLETED:
11:58 AM
ALLEGATION(S):
1
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Facility bathroom was in disrepair.
Staff did not ensure the facility was free of flies.
Facility did not follow isolation procedures for COVID positive residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced complaint investigation visit to the facility in order to deliver findings on the above allegations. LPA was granted entry to the facility by Jessica Garibay, caregiver. LPA discussed the purpose of the visit and the allegations mentioned above with Julie Norris, Licensee.

On March 14, 2023, it was alleged that facility bathroom was in disrepair, specifically that the sink faucet handle was not attached. It was also alleged that staff did not ensure that the facility was free of flies and that the facility did not follow COVID isolation procedures. The Department’s investigation consisted of review of facility records, outside source records, and interviews of facility staff and outside sources.

On March 21, 2023, LPA observed that the faucet handle in the bathroom located in the hallway, in front of

[Continued on LIC9099-C, Page 1 of 2]
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Esther MillerTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20230314083629
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: VIBRANT LIVING
FACILITY NUMBER: 374603520
VISIT DATE: 08/15/2023
NARRATIVE
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a resident’s room, was not securely attached and could easily be removed. The faucet was still functional and able to be used, despite the condition of the handle. The facility had a second bathroom in a large room that was shared by two residents. The faucet and bathroom were functional and in good repair. On August 8, 2023, LPA observed that the faucet had since been repaired and that the handle was secured on the faucet. Due to the faucet being continuously operational, the allegation that facility bathroom was in disrepair is found to be UNSUBSTANTIATED.

It was also alleged that staff did not ensure that the facility was free of flies. Outside source interviews stated that about five (5) flies were observed in the kitchen during the summer. Staff and Licensee stated that they did not recall having an issue with flies in the facility. On March 21, 2023, LPA toured the facility and did not see any type of pests, including flies. On August 9, 2023 and August 15, 2023, during the summer, LPA visited the facility and, again, did not observe any type of pests, including flies. Due to the lack of observable flies or other relevant evidence, the allegation that staff did not ensure that the facility was free of flies is found to be UNSUBSTANTIATED.

It was also alleged that staff did not follow isolation procedures for COVID positive residents. The Department documented Licensee calling to report a COVID positive resident on November 15, 2023. Licensee submitted an incident report which indicated that resident 1 (R1) received positive COVID results and was placed in isolation. Incident report also documented actions taken in response, which followed the facility’s COVID mitigation plan. Outside source documents showed that all other staff and residents were retested on November 16, 2023, with negative results. Based on interviews, outside source documents, and facility’s compliance with COVID mitigation measures, the allegation that staff did not follow isolation procedures for COVID is found to be UNSUBSTANTIATED.

Based on the evidence obtained during the complaint investigation, the allegations are found to be UNSUBSTANTIATED, meaning that although the allegations may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Licensee; a copy of this report and Licensee's Rights (LIC9058) were provided.




[Continued from LIC9099-A, Page 2 of 2]
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Esther MillerTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5