374603565-2-16-2024-08-AS-SJAB-D2VS7P-20240228123752

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603565
Report Date: 02/16/2024
Date Signed: 02/16/2024 05:06:40 PM

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
02/13/2024 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20240213091217

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: 124	DATE:	02/16/2024
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Executive Director David Armour		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Neglect/Lack of supervision resulted in injuries

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 allegation. LPA identified herself and discussed the purpose of the visit with Executive Director David Armour.

On February 13, 2024, Community Care Licensing (CCL) received a complaint alleging neglect of Resident 1 (R1) resulted in multiple injuries. During the investigation, LPA Strong collected pertinent resident records as well as facility documentation, conducted interviews and made observations.
Based on Resident 1 (R1) Physician’s Report dated January 25,2024, R1 is diagnosed with a Major Neurocognitive Disorder, diabetes, is ambulatory and is known to have sundowning behavior. According to R1’s care plan R1 moved into facility on January 31, 2024, and requires minimal assistance with ambulating.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

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-20240213091217

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: 02/16/2024

NARRATIVE

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According to allegation, on February 6, 2024, R1 was observed to have a large bruise on the front left side of head and well as bruises/scrapes on hands and arms. Interview with Director of Assisted Living revealed R1 had an unwitnessed fall on February 6, 2024. Interview established that R1 received first aid from Licensed Vocational Nurse and was taken to the emergency room, on the same day, when bruise developed on left side of face and head. Records collected revealed that R1 moved into facility with multiple bruises on arms. Interview with staff present on February 6, 2024, corroborated that R1 had an unwitnessed fall and was assessed for injuries. Interview with outside source did not reveal any information to corroborate neglect resulted in injuries. Finally, records collected established R1 was diagnosed with hypoglycemia on the date of the incident.

Based on Department’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.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

LIC9099 (FAS) - (06/04)

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