374603565-4-24-2024-08-AS-SJAB-D4TTHY-20240430144531

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603565
Report Date: 04/24/2024
Date Signed: 04/24/2024 05:32:42 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
04/22/2024 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20240422093919

FACILITY NAME:	LA VIDA REAL		FACILITY NUMBER:	374603565
ADMINISTRATOR:	GARCIA, KIMBERLY		FACILITY TYPE:	740
ADDRESS:	11588 VIA RANCHO SAN DIEGO		TELEPHONE:	(619) 660-5778
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY:	177	CENSUS: 123	DATE:	04/24/2024
		UNANNOUNCED	TIME BEGAN:	01:31 PM
MET WITH:	Executive Director Kimberly Garcia		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Licensee did not provide resident's records to the authorized representative.
Licensee did not reassess resident timely

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 Kimberly Garcia.

On April 22, 2024, Community Care Licensing (CCL) received a complaint alleging Staff 1 (S1) did not provide authorized representative with Resident 1 (R1) records and licensee did not reassess R1 in a timely manner. 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 August 4, 2023, R1 is diagnosed with a Major Neurocognitive Disorder, is confused and disoriented, is depressed and can communicate needs. According to R1’s records, R1 moved into facility on July 31, 2023, was assessed on July 25, 2023, September 15, 2023, and March 21, 2024.

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: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

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-20240422093919

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: 04/24/2024

NARRATIVE

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According to allegation, R1’s authorized representative requested R1’s assessment in November of 2023 from S1 and had not received it. Records collected confirmed that responsible party had a digital copy of the September 15, 2023, assessment. Interview with S1 revealed that there were no additional requests made for medical records. Outside sourced interview revealed facility does not have a history of not providing records to residents or their authorized representatives.

It was also alleged that R1 was not reassessed timely. Interview with S1 revealed that R1 was assessed in September of 2023, one month prior to request to be reassessed by an outside source. Interview with S1 also revealed that there were no significant changes noted to R1 requiring a new assessment at the end of 2023. Interview with S1 also revealed that R1 did have a social cognitive change in February of 2024. Records collected also established that R1 had a reassessment in March of 2024. Interview with outside source did not reveal any corroborating information that facility does not reassess residents timely.

Based on 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 Kimberly Garcia, 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: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

LIC9099 (FAS) - (06/04)

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