374603750-10-24-2024-08-AS-SJAB-DAJPDS-20241030111400

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603750
Report Date: 10/24/2024
Date Signed: 10/24/2024 02:48:03 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
10/07/2024 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20241007110409

FACILITY NAME:	VILLA LORENA		FACILITY NUMBER:	374603750
ADMINISTRATOR:	COLLADO JR, JOSE		FACILITY TYPE:	740
ADDRESS:	14740 VIA FIESTA		TELEPHONE:	(858) 583-8480
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92127
CAPACITY:	85	CENSUS: 65	DATE:	10/24/2024
		UNANNOUNCED	TIME BEGAN:	10:31 AM
MET WITH:	Resident Service Director Maureen Manzon		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Licensee did not ensure residents are assessed for proper care placement
Lack of supervision resulted in residents eloping
Licensee staff did not meet personal care needs for residents

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Amy Rodgers conducted an unannouced visit to deliver findings regarding the above-mentioned allegations. LPA introduced themselves and disclosed the purpose of the visit to Resident Service Director Maureen Manzon.

On 10/7/2024 it was alleged that Licensee did not ensure residents are assessed for proper care placement and lack of supervision resulted in residents eloping, and licensee staff did not meet personal care needs for residents. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents and outside sources, records review, and LPA observations.

It was alleged that Licensee did not ensure residents are assessed for proper care placement for four residents (R1-R4). [See LIC 811 Confidential Names List for a description of R1.] and they should be placed in the memory care unit. A review of facility records reveals there are currently four residents (R1-R4) that reside in the assisted living portion of the facility with a diagnosis of dementia, and they are unable to leave the facility unassisted. A review of physician’s reports and care plans for [R1-R4] reveal all care plans as well as medical assessments are up to date. Records review indicate residents [R1-R4] are regularly observed for changes in physical, mental, emotional, and social functioning and these changes are brought to the attention of the responsible parties. (continued on 9099]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

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-20241007110409

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: VILLA LORENA	FACILITY NUMBER: 374603750
	VISIT DATE: 10/24/2024

NARRATIVE

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[Continued form 9099]

It was alleged that lack of supervision resulted in residents [R1-R3] eloping from the Assisted living unit of the facility as well as residents from the memory care facility. A review of facility records reveals there are currently four residents (R1-R4) that reside in the assisted living portion of the facility with a diagnosis of dementia, and they are unable to leave the facility unassisted. Interviews with staff reveal inconsistent accounts of elopement in the assisted living wing of the facility, regarding R1. Interviews with staff reveal (R2-R4) do not have exit seeking behavior and staff has not observed exit seeking behaviors.

Record reviewed showed that internal investigation of a recent elopement incident was conducted, and LPA interviews and record reviews revealed the facility had in place an Absentee Notification Plan/Policy and followed the policy procedure. LPA toured the facility four times over the last three months and observed the delayed egress alarm system in the memory care unit of the facility. The annual inspection visit conducted in February 2024 also indicate delayed egress alarms working. LPA observed the alarm is operational and interviews reveal staff respond appropriately to the alarms when triggered.

It was alleged that the Licensee did not meet personal care needs for residents in the memory care unit by not receiving bathing assistance from staff which resulted in residents smelling bad. LPA conducted observations on four (4) visits in the past three (3) months in the memory care area of the facility. LPA did not notice any malodorous in the memory care unit nor did the residents in the memory care unit have a smell of incontinence. LPA observed residents were sitting in the memory care unit common room, and all looked clean and well taken care of. LPA was accompanied by S1, who toured the facility. LPA also interviewed two outside sources that frequent the unit and confirmed they have not witnessed residents smelling bad and have observed frequent bathing for all residents.

Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations were deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) was provided to Resident Service Director Maureen Manzon whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

LIC9099 (FAS) - (06/04)

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