374603565-1-10-2024-08-AS-LTEZ-D2WVXA-20240229154911

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603565
Report Date: 01/10/2024
Date Signed: 01/10/2024 05:49:25 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
09/20/2021 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20210920145646

FACILITY NAME:	LA VIDA REAL		FACILITY NUMBER:	374603565
ADMINISTRATOR:	KIMBERLY GARCIA		FACILITY TYPE:	740
ADDRESS:	11588 VIA RANCHO SAN DIEGO		TELEPHONE:	(619) 660-5778
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY:	177	CENSUS: 133	DATE:	01/10/2024
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Executive Director David Armour		TIME COMPLETED:	05:50 PM

ALLEGATION(S):

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Licensee did not have sufficient staff to meet resident care needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver findings regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director David Armour.

It was alleged that Licensee did not employ staff in sufficient numbers to meet Resident #1’s (R1) needs, because R1 called for help around 11:00 PM on a night in September 2021, facility staff did not respond to their call for help. [The complainant was anonymous and R1’s identity and room location were not made known to CCLD.]

CCLD’s investigation involved an unannounced facility tour and welfare check on residents in care and interviews of relevant staff. The Department also reviewed the facility’s posted work schedules, employee timeclock logs, and electronic pull cord / call button log, among other records. [CONTINUED ON LIC 9099-C, 1 of 2]

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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 4

Control Number 08-AS-20210920145646

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: LA VIDA REAL	FACILITY NUMBER: 374603565
	VISIT DATE: 01/10/2024

NARRATIVE

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[CONTINUED FROM LIC 9099]

Per interviews of facility managers: The facility is divided into an Assisted Living (AL) section and a Memory Care (MC) section. The MC section is further subdivided into separate “J Court” and “M Court" buildings. The PM caregiver shift ends at 11:00 PM, and the overnight (NOC) caregiver shift starts at 11:00 PM. Around the time-frame of the allegation, there were 115 total residents in care. Based on those residents’ care acuity levels at that time: PM shift was considered safely staffed if there were at least four (4) caregivers in AL and at least four (4) caregivers in MC. NOC shift was considered safely staffed if there were at least three (3) caregivers in AL and at least three (3) caregivers in MC. NOC shift was also expected to have one (1) med aide on duty to share between AL and MC; this person was cross trained and able to cover caregiving duties, if needed. Outgoing staff were expected to verbally debrief their incoming counterparts (of shift happenings) in one-to-one conversation.

According to caregiver work schedules: on the night in question, there were four (4) PM caregivers assigned to AL and four (4) PM caregivers assigned to MC. There were two (2) NOC caregivers assigned to AL and four (4) NOC caregivers in MC. Per these work schedules, Licensee had planned on meeting its caregiver staffing targets for PM and NOC shifts, at least at the net (facility-wide) level. However, employee timeclock records showed that there were a few staff whose actual timeclock entries deviated from their assigned work schedule, such that the facility was short-handed in specific sectors at specific times, which had a potential impact on resident health and safety.

According to electronic timeclock records, which were read in concert with the caregiver work schedules: On the night in question, within the MC “J Court” Building, PM Caregiver Staff #1 (S1) clocked out at 10:56 PM and PM Caregiver Staff #2 (S2) clocked out at 10:57 PM. The early departure of S1 and S2 was not counteracted by either of their two “J Court” NOC relief caregivers starting work early [i.e., NOC Caregiver Staff #3 (S3) clocked in at 11:00 PM, and NOC Caregiver Staff #4 (S4) clocked in late at 11:05 PM.] Although there was one NOC Med Aide Staff #5 (S5) who was on duty at the time and able to cover caregiving tasks in AL, the result was that MC “J Court” was still short-handed by one staff during a brief time-period that was relevant to the complaint allegation.

[CONTINUED ON LIC 9099-C, 2 of 2]

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 08-AS-20210920145646

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: LA VIDA REAL	FACILITY NUMBER: 374603565
	VISIT DATE: 01/10/2024

NARRATIVE

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[CONTINUED FROM LIC 9099-C, 1 of 2]

On the night in question, within the AL Building: NOC Caregiver Staff #6 (S6) was 44 minutes late to work (i.e. clocked in at 11:44 PM). There was just one other NOC caregiver teammate, Staff #7 (S7), assigned to the AL building, instead of the usual two. While some PM staff lingered on duty beyond the end of their shift, the last PM staff person clocked out at 11:22 PM, rather than remaining on duty until S6 arrived. For the next 22 minutes, AL section was short-handed by at least one staff during a brief time-period relevant to the complaint allegation.

Based on interviews and records, a preponderance of evidence exists to show that for a portion of the night in question, Licensee did not employ staff sufficient in numbers to meet a resident's care needs. The allegation is therefore substantiated. One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the licensee.

An exit interview was conducted with Armour, to whom a copy of this report, the LIC 9099-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 08-AS-20210920145646

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: LA VIDA REAL	FACILITY NUMBER: 374603565
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/10/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/09/2024 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements – General: “(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.” This requirement was not met, as evidenced by:	1 2 3 4 5 6 7	License agreed to retrain its current direct care staff on the following expectations: a) The posted shift end time is the time staff should physically depart the caregiving floor to walk to the timeclock, not the time staff clock out; b) The posted shift start time is the time staff should physically arrive on the caregiving floor after they have walked there from the timeclock; c) Shift leaders (i.e., nurses and med aides) should monitor for any late arrival notices from incoming staff, and ask for volunteers from the outgoing shift to stay on longer, if possible, until the late person arrives, particularly if the shift in that area is already running lean; and, d) Excessive occurrences of tardiness may warrant discipline according to company policy. Licensee agreed to E-mail the training sign-in sheet to LPA, by the POC due date.
	8 9 10 11 12 13 14	Based on interviews and records, during the incident in question, Licensee did not ensure facility personnel were sufficient in numbers to provide the services necessary to meet the needs of 1 of 115 residents (R1), which posed a potential health and safety risk to persons 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: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC9099 (FAS) - (06/04)

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