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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603565
Report Date: 12/19/2025
Date Signed: 12/19/2025 02:53:13 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
05/07/2025 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250507102306
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: 130DATE:
12/19/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator Kimberly GarciaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Lack of Supervision resulted in serious bodily injury.
Facility charged resident for services not rendered.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings in the above complaint allegations. LPA identified herself and discussed the purpose of the visit with Administrator Kimberly Garcia.

On May 7, 2025, Community Care Licensing (CCL) received a complaint alleging lack of supervision resulted in serious bodily injury to Resident 1 (R1) (R1 – see LIC811 Confidential Names List) and R1 was charged for services not rendered. Physician’s Report dated March 28, 2025, states R1’s primary diagnosis is mechanical fall and is not able to leave facility unassisted. R1’s Service Plan dated April 7, 2025, established that R1 requires extensive assistance with ambulation and escorting to and from activities and meals while being considered a fall risk due to a history of falls.

Details of the allegation state that on April 24, 2025, R1 left the facility unassisted, walked one mile and fell at a nearby supermarket which resulted in a fractured hip. Video surveillance collected revealed that R1 was observed leaving the facility at 1:40pm.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
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 4
Control Number 08-AS-20250507102306
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: 12/19/2025
NARRATIVE
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Interview with a witness revealed that R1 was found unaccompanied and on the ground of the supermarket parking lot at around 3:00pm. Records collected from emergency personnel show that on April 24, 2025, at 2:56pm, emergency personnel were contacted to assist on the scene for an elderly fall at the exact address of the supermarket. R1 progress notes revealed that at 3:30pm, R1’s responsible party contacted the facility to report R1’s fall which had resulted in a fractured hip. Interview with R1 established that R1 was regularly allowed to walk freely throughout the facility including the courtyard which leads to the main road with no physical barrier. Video surveillance also revealed that as R1 was walking out of the facility, both the Executive Director and the Business Office Manager were behind R1, but video did not reveal actions taken by either to prevent R1 from leaving. Interview with the Director of Assisted Living established that R1 was regularly allowed to walk the courtyard unescorted and direct staff supervision was not consistently provided. Medical records collected revealed that R1 was diagnosed with closed fracture of right hip status post fall. The Department received information that R1 died on September 12, 2025. Official Death Certificate established that primary cause of death was hypertensive and atherosclerotic cardiovascular disease with significant condition attributing to death but not resulting in the underlying cause given was remote blunt force injury with right hip fracture while place of injury was identified as a parking lot.

It was also alleged that R1 was charged for services not rendered. According to R1’s signed admissions agreement, R1 was assessed at Care Level II. Admissions agreement defines Level Care II care as 61-120 points per day of assistance with personal assistance and care services and costs an additional $2100 per month. Within R1’s Health and Services Evaluation Results completed on April 7, 2025, R1 was assessed with a total of 114 points, identifying bathing at 16 points, grooming assistance at 15 points, dressing at 20 points, toileting at 30 points, ambulation/escorting at 25 points, meal consumption as 3 at points and special care at 5 points. Additionally, in R1’s Service Plan dated April 7, 2025, R1 requires extensive assistance and requires total assistance or wheelchair escort to and from activities, meals, etc. by one staff member. Interview with multiple staff revealed R1 is regularly allowed to walk the facility premises unassisted or monitored. Interview with R1 prior to death, revealed R1 received little to no assistance while living at the facility. Based on the information collected, R1 was assessed for services to meet their individual need and such services were not provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20250507102306
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: 12/19/2025
NARRATIVE
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Based on interviews conducted, review of records, including outside sources records, a preponderance of evidence exists to support the allegation lack of supervision resulted in R1 sustaining serious injury and R1 was charged for services not rendered by facility. The allegations are therefore substantiated. Two deficiencies are being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D).

The Department has determined this violation resulted in a serious injury to the resident in care. An immediate Civil Penalty of $500.00 is charged and is noted on the LIC421IM. Additionally, two repeat violations have occurred therefore two $250 Civil Penalties will be assessed on the LIC421FC Currently, according to Health and Safety Code Section 1569.49, an additional civil penalty assessment is under review by the Program Administrator of Community Care Licensing Division. An exit interview was conducted with Administrator, and a Plan of Correction was jointly developed. A copy of this report, LIC811, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to Administrator Kimberly Garcia, signature on this form confirms receipt of documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20250507102306
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: 12/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/20/2025
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 that after the incident, all care staff and receptionist received training on elopment. Licensee states they will attain certified outside sourced training for all staff in regards to elopement and will provide proof of scheduled training via email to LPA.
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Based on interviews and record reviews the licensee did not provide R1 with supervision in 1 of 124 people in care which posed an immediate health and safety risk to persons in care.
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Type B
01/02/2026
Section Cited
CCR
87468.2(a)(4)
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87468.2 (a) ...residents in privately operated residential care facilities ... shall have all of the following personal rights: (4)To ...services that meet their individual needs and are delivered by staff that are sufficient in numbers... and competency to meet their needs.
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Licensee states they will provide certified outside source training for all staff in regards to meeting resident individual needs and will provide proof to LPA via email.
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This requirement was not met as in evidence:
Based on interviews and record reviews the licensee did not provide R1 with services that met their individual need in 1 of 124 people in care which posed an potential safety 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: 12/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4