374603664-6-22-2020-08-AS-IESA-BR45S6-20200630201214

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603664
Report Date: 06/22/2020
Date Signed: 06/22/2020 01:02:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/20/2020 and conducted by Evaluator Evangelica Torres

COMPLAINT CONTROL NUMBER: 08-AS-20200220114616

FACILITY NAME:	VISTA DEL LAGO MEMORY CARE		FACILITY NUMBER:	374603664
ADMINISTRATOR:	JEFF GONZALEZ		FACILITY TYPE:	740
ADDRESS:	1817 AVENIDA DEL DIABLO		TELEPHONE:	(760) 741-2888
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92029
CAPACITY:	96	CENSUS: 83	DATE:	06/22/2020
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Administrator, Jeff Gonzalez		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Licensee failed to meet Resident's #1 care needs
Licensee failed to address the infestation of bedbugs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Eva Torres conducted a virtual visit via FaceTime to deliver findings on the above allegation(s) due to COVID-19. LPA identified herself, spoke with Administrator, Jeff Gonzalez, and disclosed the purpose of the phone call. The investigation included a review of facility and outside source’s records, as well as interviews conducted.

It was alleged that the facility failed to meet Resident’s #1 (R1) (See LIC 811- Confidential Names List) care needs, as well as address the infestation of bedbugs.

On 11/06/19, staff observed bedbugs on the headboard of the R1's bed. Staff immediately reported their observation, contacted pest control, notified the physician, and removed all of R1's personal belongings from their bedroom. Resident Service Director assessed R1’s skin for symptoms of dermis irritation, but no signs of dermatitis was observed. On the same day, the pest control company conducted an on-site visit and treated R1’s bedroom for bedbugs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Evangelica Torres	TELEPHONE: (619) 990-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2020

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-20200220114616

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VISTA DEL LAGO MEMORY CARE	FACILITY NUMBER: 374603664
	VISIT DATE: 06/22/2020

NARRATIVE

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On 11/24/19, R1’s treating physician assessed R1’s skin and observed no abnormalities. On 11/29/19, staff observed a rash on R1’s skin and notified all essential parties. On 11/30/19, R1 was prescribed medication to treat the inflammation of the skin. On 12/06/19, a Nurse Practitioner (NP) conducted an on-site visit to assessed the health of R1’s skin. Based on the NP's assessment, two additional medication were prescribed to treat skin and a referral was also made to see the Dermatologist. On 12/14/19, R1 was evaluated by a Dermatologist and a skin exam was performed. The test confirm a new diagnose, in which new prescription was prescribed.

On 01/22/20, staff observed scabs on R1’s skin and reported their observation. On 01/25/20, R1 was prescribed medication to assist with the itching. On 01/28/20, NP conducted another follow up visit, reassess R1’s skin condition, and recommended that R1 follow up with the Dermatologist. On 02/12/20, R1 was seen by the Dermatologist and received new orders to continue the skin treatment.

A review of the pest control invoices revealed that the company conducted multiple on-site facility visits to inspect and treat the suspected areas for bedbugs. Moreover, the review of the Medication Administration Records System produce no evidence to support discrepancies in the administration of medication.

Outside sources to include the responsible parties were also interviewed and their interviews did not reveal corroborating evidence to confirm that either of the allegations occurred.

Based on interviews conducted and a review of documents, there is insufficient evidence to prove or disprove that the allegation(s) occurred; therefore, the complaint investigation findings is found to be Unsubstantiated.

An exit interview was conducted with Administrator, Jeff Gonzalez, and the Licensee’s Rights (LIC9058 01/15) along with a copy of this report was provided to Administrator Gonzalez via email. A reply email or return receipt from the administrator will confirm receipt of documents.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Evangelica Torres	TELEPHONE: (619) 990-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2020

LIC9099 (FAS) - (06/04)

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