374603565-11-17-2023-08-AS-DPOL-CY42NF-20231130163241

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603565
Report Date: 11/17/2023
Date Signed: 11/17/2023 04:40:26 PM

Substantiated

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
11/13/2023 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20231113095405

FACILITY NAME:	LA VIDA REAL		FACILITY NUMBER:	374603565
ADMINISTRATOR:	DAVID ARMOUR		FACILITY TYPE:	740
ADDRESS:	11588 VIA RANCHO SAN DIEGO		TELEPHONE:	(619) 660-5778
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY:	177	CENSUS: 129	DATE:	11/17/2023
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	David Armour, Executive Director		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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- Facility did not maintain resident’s bathroom in sanitary condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility LPA investigated and delivered findings regarding the above-mentioned allegation. LPA identified herself and was granted entry by Lyn Aquino, Receptionist. LPA stated the purpose of the visit and reviewed the findings of the complaint with Executive Director David Armour and Kristin Molina, Enliven Director.

The Department’s investigation consisted of interviews with staff and outside sources, LPA observations, and records review of relevant documents pertinent to this investigation. On November 13, 2023, it was said that the facility did not maintain resident’s bathroom in a sanitary condition.

It was specifically alleged that the facility staff did not replace resident #1’s (R1) lavatory cover timely that resulted in unsanitary conditions inside the tank. Interview with Maintenance Director said that they obtain about 30 work orders daily and about 1,100 work orders monthly. They categorize work orders based on emergencies.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

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-20231113095405

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: LA VIDA REAL	FACILITY NUMBER: 374603565
	VISIT DATE: 11/17/2023

NARRATIVE

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There are 6 maintenance assistants who the work orders are assigned to by category (plumbing, electrical, etc.). The front desk reception area originates the work order’s through their internal system. When a work order is submitted, their system then sends out a signal to their work cellular phone informing them of a new work item. There may be times when unexpected occurrences transpire, and a work order may not be submitted through their internal system, but the work would still be completed. Interview with Enliven Director said that they were unaware that there was an issue with R1’s bathroom until they received a notice from the family about one week ago which was immediately addressed. According to the Executive Director, it took the facility about three days to ensure the toilet and the “worm” issues were addressed. A review of maintenance records revealed that a work order was submitted on or about September 7, 2023, for a toilet cover in R1’s suite to be fixed. There was only one work order specifically for R1’s toilet cover submitted in their internal system in the last six months. An email dated November 08, 2023, revealed that the toilet cover was still needed and the tank was in need to be sanitized due to worms. Video footage was made available and disclosed there were small worm-like insects inside the lavatory tank. On November 17, 2023, LPA toured the facility. During the tour, LPA entered into R1’s room and observed the toilet cover was fixed and there were no worms in R1’s lavatory tank. Based on the evidence obtained there is enough evidence to support the allegation.

Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff and outside source interviews, records reviewed, and LPA observations, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099D.

The report was discussed, plan of correction was jointly developed and cleared, and an exit interview was conducted with Executive Director David Armour and Perla Provencal, Director of Assisted Living. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Executive Director David Armour at the conclusion of the visit. The signature below confirms the receipt of these documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20231113095405

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: LA VIDA REAL	FACILITY NUMBER: 374603565
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/17/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/17/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303(a) Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times… this requirement was not met as evidence by:	1 2 3 4 5 6 7	Due to LPA observations during the visit, the POC has been cleared.
	8 9 10 11 12 13 14	Based on documentation, staff did not fix R1’s toilet tank cover timely resulting in worms breeding inside the tank. This posed a potential personal rights risk to 1 of 306 [R1] residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

LIC9099 (FAS) - (06/04)

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