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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603565
Report Date: 09/05/2025
Date Signed: 09/05/2025 03:40:29 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
06/09/2025 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250609110429
FACILITY NAME:LA VIDA REALFACILITY NUMBER:
374603565
ADMINISTRATOR:GARCIA, KIMBERLYFACILITY TYPE:
740
ADDRESS:11588 VIA RANCHO SAN DIEGOTELEPHONE:
(619) 660-5778
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:177CENSUS: 126DATE:
09/05/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH: Business Office Manager Kristin MolinaTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff did not ensure resident is provided feeding assistance
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings in the above complaint allegation. LPA identified herself and discussed the purpose of the visit with Business Office Manager Kristin Molina.

On June 9, 2025, Community Care Licensing (CCL) received a complaint alleging staff did not ensure resident is provided feeding assistance. During the investigation, the Department conducted interviews, and reviewed facility records.

According to the allegation Resident 1 (R1) was not being provided with feeding assistance as needed. Records collected revealed that R1 required extensive prompting throughout meals and may require assistance, additionally R1 has difficulty communicating needs. Interview with an outside source revealed that R1 was often found in room with food on lap or on the floor. Source also stated that it appeared R1 had not had any food assistance on multiple days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
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 5
Control Number 08-AS-20250609110429
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: 09/05/2025
NARRATIVE
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 Interview with R2 revealed that R2 has asked multiple times for assistance in eating and has waited up to thirty minutes for assistance. R2 also revealed that they must plead to staff to be taken to the dining room to eat as R2 does not want to be in room all day.

Based on interviews conducted, review of records, including outside sources records, a preponderance of evidence exists to support the allegation. A deficiency is cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Business Office Manager Kristin Molina Kristin Molina to whom a copy of this report, Appeals rights, LIC9099 C and LIC9099D were provided to.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20250609110429
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: 09/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2025
Section Cited
CCR
87464(f)(1)
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87464 Basic Services.(f)Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).
This requirement was not met as in evidence:
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Licensee states staffing has been adjusted as of July 2025 and will provide staff with inservice training regarding resident change in conditions. Licensee will provide LPA with training documentation by POC date.
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Based on interviews and records reviewed the licensee did not provide assitance in feeding in 1 of 126 persons in care (R1) which posed a potential Health and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
06/09/2025 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250609110429

FACILITY NAME:LA VIDA REALFACILITY NUMBER:
374603565
ADMINISTRATOR:GARCIA, KIMBERLYFACILITY TYPE:
740
ADDRESS:11588 VIA RANCHO SAN DIEGOTELEPHONE:
(619) 660-5778
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:177CENSUS: DATE:
09/05/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Business Director Kristin Molina TIME COMPLETED:
03:40 PM
ALLEGATION(S):
1
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9
Staff did not provide resident with special diet according to resident’s health care needs
Staff did not ensure resident was properly positioned in recliner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced complaint visit to deliver findings on the above-mentioned allegations. LPA met with Business Office Manager Kristin Molina and discussed the purpose of the visit.

On June 9, 2025, Community Care Licensing (CCL) received a complaint alleging staff did not provide resident with special diet according to resident’s health care needs and staff did not ensure resident was properly positioned in recliner. During the investigation, the Department conducted interviews, and reviewed facility records.

According to the first allegation Resident 1 (R1) was not being provided with pureed food. Records collected revealed that R1 was on end-of-life services and a mechanical soft diet was requested by such agency. Interview with an outside source revealed R1 was receiving a pureed diet. Interview with multiple staff revealed R1 was receiving specialized diet as required. Interview with Food Services Director also established that R1 was being served specialized diet.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20250609110429
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: 09/05/2025
NARRATIVE
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It was also alleged that staff did not ensure R1 was properly positioned in recliner and was often found slouched in recliner. Interview with outside source revealed that R1 had not been observed being left in recliner in slouching position for an extended period. Interview with staff revealed R1 was repositioned often.
Based on interviews, and record reviews there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Business Office Manager Kristin Molina, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.







SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5