374603565-11-14-2023-08-AS-SJAB-CY3Q8X-20231130105727

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603565
Report Date: 11/09/2023
Date Signed: 11/14/2023 10:57:34 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
11/06/2023 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20231106144709

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: 131	DATE:	11/09/2023
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Executive Director David Armour		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Staff did not assess residents after falls
Staff did not ensure residents are protected against hazards.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to initiate a complaint investigation on the above-mentioned allegations. LPA identified herself and discussed the purpose of the visit with Executive Director David Armour. Memory Care Director Kristen Molina arrived shortly after.

On November 6, 2023, Community Care Licensing (CCL) received a complaint alleging staff did not accurately assess resident after a fall and staff did not protect resident from hazards.

During investigation, LPA Strong collected pertinent resident records as well as facility documentation and conducted interviews. According to allegation, staff is going against facility policy and assisting residents after falls without prior consent of Licensed Vocational Nurse or Medical Technician (MedTech) on shift. Interviews with staff revealed that the facility has a policy for caregivers not to evaluate resident’s after falls rather contact nurse or MedTech on shift.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

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-20231106144709

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: 11/09/2023

NARRATIVE

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Continuation from LIC9099

Interview with staff also revealed that caregivers have assisted residents after falls after conducting a basic assessment themselves. Interview with outside source did not reveal any information to corroborate facility is not assessing residents after falls.

It was also alleged that Resident 1 (R1) had hazardous nightstand in their room, causing them injury. Interview with R1 revealed that R1 had a fall and hit head on nightstand causing a cut on the forehead. LPA Strong observed a standard wooden nightstand with pointed corners. Interview with outside source revealed that the furniture piece was not hazardous, rather R1 fell and in doing so hit the nightstand.

Based on LPA's interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Executive Director David Armour, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC9099 (FAS) - (06/04)

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