374603565-1-10-2024-08-AS-LTEZ-D2W2YG-20240228164844

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603565
Report Date: 01/10/2024
Date Signed: 01/10/2024 05:17:42 PM

Unsubstantiated

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
05/28/2021 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20210528161206

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:	03:45 PM
MET WITH:	Executive Director David Armour		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Facility staff did not give medication as prescribed.

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 around April 2021 and May 2021, Licensee did not give Resident #1 (R1) their as-needed suppository (for treatment of constipation) as it was prescribed. Specifically, the complainant alleged the suppository was given too infrequently to address R1’s constipation needs. CCLD’s investigation involved an unannounced facility tour and welfare check on R1, review of R1’s pertinent facility care and hospice records, and interviews of relevant facility staff and outside sources.

[CONTINUED ON LIC 9099-C]

Unsubstantiated

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)

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Control Number 08-AS-20210528161206

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]

According to R1’s prescribed medication orders: During the time-frame of the complaint, R1’s had only one medication which was in suppository form. R1’s doctor determined that this suppository could be given “rectally every day as needed for constipation, not to exceed one dose per 24 hours.” The prescription limited only the maximum amount to be given in a day; it did not specify a maximum number of days R1 could go without a bowel movement (BM) before the suppository was required to be given.

According to the facility’s Medication Administrator Records (MARs): During April 2021, R1 was given the suppository once on 04/05/2021 (resulting in a medium BM), and once on 04/24/2021 (resulting in a large BM). During May 2021, R1 was given the suppository once on 05/04/2021 (resulting in a large BM), and once on 05/16/2021 (resulting in an extra-large BM).

According to the facility’s Bowel Movement Logs: During April 2021, R1 had a total of 28 BMs, of which 23 BMs occurred on days when no suppository was given. On the two days when the suppository was given, R1 had not had a BM during the preceding four days. On all other days in April 2021, R1 had at least one BM every two days. During May 2021, R1 had a total of 24 BMs, of which 20 BMs occurred on days when no suppository was given. On the first day the suppository was given, R1 had not had a BM in the preceding three days. On the second day the suppository was given, R1 had not had a BM in the preceding two days. On all other days in May 2021, R1 had at least one BM every day, or every other day.

According to R1’s LIC602 Physician’s Report (dated 10/15/2020): R1 was diagnosed with Alzheimer’s Disease. R1’s hospice agency records and facility care records corroborated this. Due to their baseline memory loss, R1 was unable to be a reliable historian/interviewee for this investigation.

Based on record reviewed and interviews, a preponderance of evidence does not exist to prove that licensee did not give R1’s suppository as it was prescribed and needed by R1. The allegation is therefore unsubstantiated.

An exit interview was conducted with Armour, to whom a copy of this report 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)

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