374603565-5-29-2024-08-AS-SJAB-D5SVBZ-20240531161822

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603565
Report Date: 05/29/2024
Date Signed: 05/29/2024 04:03:03 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
05/20/2024 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20240520145305

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: 116	DATE:	05/29/2024
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Executive Director Kimbery Garcia		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Neglect resulted in pressure injury
Neglect resulted in resident sustaining falls
Staff refused to provide resident with meals

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 May 20, 2024, Community Care Licensing (CCL) received a complaint alleging neglect of Resident 1 (R1) resulted in a pressure injury, neglect of R1 resulted in falls and staff refused to provide R1 with meals. During the investigation, LPA Strong collected pertinent resident records as well as facility documentation and conducted interviews. According to R1’s medical records, R1 has a major neurocognitive impairment, can communicate need, is bedridden and requires assistance with toileting.

According to allegation staff neglect has resulted in R1 having an undescribed pressure injury. Records collected revealed R1 does not have any current pressure injuries. Interview with outside medical source revealed R1 did have a pressure injury in December of 2023, but injury has since then healed.

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: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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-20240520145305

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: 05/29/2024

NARRATIVE

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Outside source also revealed that R1 does have redness on back side but not enough to be considered a pressure injury. Interview with additional outside source did not reveal any information to corroborate that R1 neglect by facility staff has resulted in pressure injury.

It was also alleged that R1 neglect has resulted in multiple R1 falls. Records collected revealed that R1 does have a fall risk. Interview with staff revealed R1 tends to move self-off of bed and onto the floor but does not fall. Records also revealed that R1 is checked-on multiple time throughout the day. Interview with outside medical source also corroborated that R1 tends to have episodes of agitations and puts themselves on the floor. Records and interviews did not reveal R1 has sustained any injuries from these incidents.

Lastly, it was alleged that R1 has been fearful of staff not providing meals to R1. Interview with staff revealed R1 receives three meals per day. Interview with outside source established that outside source has not been informed of R1 not receiving meals. Records reviewed revealed that R1 has received multiple meals on today’s visit, May 29, 2024.

Based on LPA's 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 Executive Director 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: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

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