374603530-4-24-2024-08-AS-SJAB-D4MVXY-20240424165015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603530
Report Date: 04/24/2024
Date Signed: 04/24/2024 11:42:41 AM

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
09/29/2020 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20200929131257

FACILITY NAME:	MISSION VILLA WEST		FACILITY NUMBER:	374603530
ADMINISTRATOR:	ALEXANDER LIMPIN		FACILITY TYPE:	740
ADDRESS:	2335 CAMINO DEL RIO SOUTH		TELEPHONE:	(619) 501-1244
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92108
CAPACITY:	0	CENSUS: 0	DATE:	04/24/2024
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Report Mailed to former licensee via USPS Certified Mail		TIME COMPLETED:	02:17 PM

ALLEGATION(S):

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Staff did not administer medication as prescribed
Staff withheld food from resident
Staff did not supervise resident(s) at night

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano sent this report to the former licensee at their last known mailing address via USPS certified mail and via email to deliver the investigation findings for the above allegation. The facility ceased operations on or about October 5, 2023.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of interviews with facility staff, resident and outside sources.

It was reported to CCL that staff did not administer medication as prescribed to Resident 1 (R1) [an LIC 811 Confidential Names List was provided to the facility representative to identify the resident.] It was reported that R1 was being given another residents medications and R1 was not allowed to view the medication bottles or packaging. While R1 claimed they were not allowed to view their medication bottle or package, interview with staff member 1 (S1) revealed that residents are typically allowed access to view their medications if they wish.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

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-20200929131257

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: MISSION VILLA WEST	FACILITY NUMBER: 374603530
	VISIT DATE: 04/24/2024

NARRATIVE

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S1 further stated that she is the staff member that passed out medications on Tuesdays and Wednesdays. S1 stated that she would put the medication in the residents' hand and wait for them to take it. S1 stated that if a resident refused to take their medication, she would take it back from their hand and put it back in the medication cabinet. LPA interviewed Resident 2 (R2) who lived at the facility during the time period of the allegations. R2 stated that although R2 had no desire to view their medication bottles or packaging, R2 believes that staff would allow them to view or read the medication packaging upon request.

It was alleged that staff withheld food from R1. Interview with R2 revealed food had never been withheld from them and they have never been denied food. LPA interviewed S1 who stated that she has never witnessed or heard of any staff withholding food or denying food to a resident for any reason.

It was alleged that staff did not supervise resident(s) at night. LPA interviewed R2 who stated that R2 often walks around at night and R2 has witnessed staff check up on their neighbor and the other residents quite often at night. LPA interviewed S1 who stated that all of the residents are checked on two to three times a night, especially if they are agitated. S1 stated that staff only log in information at night if an incident occurred such as a fall.

Interview with outside agency (OA) revealed that during the OA's multiple visits to the facility, no instances of the alleged misconduct were observed or reported. Their observations align with the findings of this investigation, further supporting the lack of substantiated evidence regarding the allegations.

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.

A copy of this report along with Licensee/Appeal Rights (LIC 9058) was mailed via USPS Certified Mail to the former licensee’s mailing address on file.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

LIC9099 (FAS) - (06/04)

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