374603565-8-30-2024-08-AS-SJAB-D9EUQ2-20240924154624

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603565
Report Date: 08/28/2024
Date Signed: 08/30/2024 03:43:10 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
01/13/2023 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230113142615

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: 115	DATE:	08/28/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Executive Director Kimberly Garcia		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff failed to response to resident call button in a timely manner.
Facility staff did not issue medication as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced complaint visit to deliver findings in the above-mentioned allegations. LPA met with Executive Director Kimberly Garcia and discussed the purpose of the visit.

On January 13, 2023, Community Care Licensing (CCL) received a complaint alleging staff failed to respond to resident call button in a timely manner and staff did not issue medication as prescribed. During investigation, LPA Strong collected pertinent resident records as well as facility documentation and conducted interviews.

According to allegation, on January 12, 2023, Resident 1 (R1) pressed their call button for assistance and staff took about one hour to respond. Call button records revealed that on the January 11, 2023, at 3:37pm R1 waited 82 minutes for assistance, on January 12, 2023, at 1:55pm R1 waited 21 minutes for assistance, then at 2:57pm R1 waited 40 minutes. Again, on January 14, 2023, R1 waited 46 minutes before being assisted. Interview with Assisted Living Director (ALD) revealed that staff are expected to respond to call buttons within 10-15 minutes.

Substantiated

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: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

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-20230113142615

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: 08/28/2024

NARRATIVE

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Interview also revealed that R1 is a two person assist requiring additional staff per call, ALD explained R1 would need to wait for two staff to be available for assistance.

It was also alleged that on January 12, 2023, at around noon, R1 requested medication for pain, which is prescribed as needed, but it was not provided to R1. Interview with Licensed Vocation Nurse (LVN) present on the date of incident revealed that they could not confirm that the medication was in fact given. Interview with Medication Aid (MA) present on the date of the incident revealed that they also did not issue the medication. Medication administration record revealed that R1 was not issued medication on January 12, 2023, until 9:30pm, when it was requested from another staff present. Medication prescription reviewed shows such pain medication may be administered as needed up to four doses per 24 hour period, there were no additional doses issued on this date.

Based on interviews, and records reviewed, a preponderance of evidence exists to support the allegations. Deficiencies are being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Executive Director Kimberly Garcia, to whom a copy of this report, LIC 9099-C, LIC 9099-D, 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: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230113142615

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: 08/28/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/11/2024 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	Personnel Requirements-Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidence by:	1 2 3 4 5 6 7	Licensee is actively working on resident response time with carestaff and management. Licensee agrees to provide proof of action taken to LPA via email.
	8 9 10 11 12 13 14	Based on interviews and records reviewed the licensee did not provide suffient staffing to respond timely to 1 of 65 persons in care [R1] which posed a potential Personal Rights risk to persons in care.	8 9 10 11 12 13 14
Type B 09/11/2024 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (a) (4) The licensee shall assist residents with self-administered medications.	1 2 3 4 5 6 7	Licensee agrees to provide a training for medication to all care staff within two weeks and provide proof to LPA via email.
	8 9 10 11 12 13 14	Based on interviews and records reviewed the licensee did not assist R1 with medication in 1 of 65 persons in care [R1] which posed a potential Personal Rights risk to persons in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC9099 (FAS) - (06/04)

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