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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603750
Report Date: 01/19/2023
Date Signed: 01/19/2023 01:26:05 PM

Substantiated


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
03/11/2022 and conducted by Evaluator Rebecca A Ruiz
COMPLAINT CONTROL NUMBER: 08-AS-20220311144118
FACILITY NAME:VILLA LORENAFACILITY NUMBER:
374603750
ADMINISTRATOR:COLLADO JR, JOSEFACILITY TYPE:
740
ADDRESS:14740 VIA FIESTATELEPHONE:
(858) 756-9600
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY:85CENSUS: 67DATE:
01/19/2023
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Amy SalvadorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not meet the minimum qualifications
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint investigation visit to conduct follow up and deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Resident Care Director Amy Salvador, Memory Care Director Marie Lou Fikingas, and Business Office Manager Nora Garza.

During today’s visit, LPA toured the facility, observed residents in care, reviewed and obtained copies of facility records, and interviewed staff.

The Department’s investigation consisted of interviews, records review, and tour of the facility. It was alleged that staff did not meet minimum qualifications. Record review of a random selection of staff files revealed that staff were 18 years of age or older at the time of hire and staff files contained health screenings that determined that staff were in good health and able to able to perform their assigned duties. Continued on LIC9099-C page...
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
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 3
Control Number 08-AS-20220311144118
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: VILLA LORENA
FACILITY NUMBER: 374603750
VISIT DATE: 01/19/2023
NARRATIVE
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Review of the Department clearance system revealed that all staff reviewed have a current background clearance. Review of staff files revealed that staff 1 (S1) did not meet the required annual training hours for 2020 or 2021. [Resident Care Director was provided with an LIC811 Confidential Names List to identify S1] Interviews revealed that S1 has been employed at the facility since 2020 and has not taken a leave of absence.

The Department has investigated the above-mentioned allegation and based on record review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency is cited per CA Code of Regulations, Title 22, and noted on the attached LIC9099-D page.

An exit interview was conducted with Resident Care Director Amy Salvador, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20220311144118
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: VILLA LORENA
FACILITY NUMBER: 374603750
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2023
Section Cited
HSC
1569.625(b)(2)
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1569.625 Staff training, legislative findings, contents (b)(2) In addition to paragraph (1) training requirements shall also include an additional 20 hours annually... This requirement has not been met as evidenced by:
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Resident Care Director (RSD) stated the facillity will implement an annual review of staff files to ensure staff have met training requirements and S1 will complete annual training. RSD stated she will submit annual review policy and proof of S1 annual training to LPA by POC due date.
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Based on record review, the Licensee did not ensure that S1 had completed the 20 hours of annual training for 2020 and 2021. This poses a potential safety risk to 67 of 67 residents 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.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3