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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603565
Report Date: 09/26/2023
Date Signed: 09/26/2023 10:57:35 AM


Document Has Been Signed on 09/26/2023 10:57 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:LA VIDA REALFACILITY NUMBER:
374603565
ADMINISTRATOR:DAVID ARMOURFACILITY TYPE:
740
ADDRESS:11588 VIA RANCHO SAN DIEGOTELEPHONE:
(619) 660-5778
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:177CENSUS: 90DATE:
09/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Human Resources Coordinator Tasha SmithTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Other visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Human Resources Coordinator Tasha Smith.

During today’s visit, LPA briefly toured the facility, interviewed staff, and reviewed written correspondence and personnel records. LPA also reviewed with licensee a signed/executed CDSS Decision and Order (D&O), which excluded Staff #1 (S1) from employment at the facility. [See LIC811 Confidential Names List for a description of S1.]

Manager interview, corroborated by personnel records, showed: From 05/05/2023 through 09/09/2023, Licensee allowed S1 to work as a full-time employee of the facility, despite Licensee not receiving positive written confirmation from CCLD showing that S1 had received criminal record clearance. Licensee subsequently realized that S1 was not background-cleared, nor eligible for a criminal record exemption. Starting 09/09/2023, Licensee removed S1 from contact with residents. On 09/19/2023, Licensee administratively terminated S1’s employment.

A preponderance of evidence exists to show that for a period of time, Licensee allowed S1 to work at the facility without either a California criminal record clearance or a criminal record exemption. One (1) deficiency was thus cited per California Code of Regulations, Title 22. An immediate civil penalty of $500 was assessed today for a Criminal Record Clearance violation (see attached LIC 421-BG).

An exit interview was conducted with Smith, to whom a copy of this report, the LIC809-D, the LIC421-BG, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/26/2023 11:03 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/26/2023 11:02 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: LA VIDA REAL
FACILITY NUMBER: 374603565

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2023
Section Cited
CCR
87355(e)(1)

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87355 Criminal Record Clearance: “(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department…” This requirement was not met, as evidenced by:
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Manager interview and employment records corroborate that S1’s employment at the facility was terminated on 09/19/2023. This action resolves the deficiency.
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Based on records and interviews: Licensee did not ensure that S1 (who was subject to a criminal record review) obtained a California clearance or a criminal record exemption prior to working at the facility, which posed an immediately safety 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: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023
LIC809 (FAS) - (06/04)
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