374603750-3-12-2024-08-AS-SJAB-D3PURS-20240325154913

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603750
Report Date: 03/12/2024
Date Signed: 03/12/2024 11:37:10 AM

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
03/17/2022 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20220317135636

FACILITY NAME:	VILLA LORENA		FACILITY NUMBER:	374603750
ADMINISTRATOR:	COLLADO JR, JOSE		FACILITY TYPE:	740
ADDRESS:	14740 VIA FIESTA		TELEPHONE:	(858) 756-9600
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92127
CAPACITY:	85	CENSUS: 62	DATE:	03/12/2024
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Jose "Joey" Collado,Executive Director & Amy Salvador Resident Service Director		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Resident eloped
Staff not following resident's care plan
Staff did not notice resident's change in condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close out the complaint investigation regarding the above-mentioned allegations. LPA identified herself and met with Jose "Joey" Collado,Executive Director
& Amy Salvador Resident Service Director, to discuss the purpose of the visit and elements of the complaint.

On or around February 2022, it was alleged that the resident eloped. Interviews revealed Resident 1 (R1) usually takes walks around the facility. Interviews revealed that R1 walks along the perimeter of the facility a few times a day. R1 has not eloped from the facility. The facility is surrounded by a large gate and R1 does walk outside of the facilty and there is a sitting area out there that R1 will go sit at. Interviews revealed if R1 does walk any further staff are close behind. R1 loves to walk/exercise and will walk back and forth. There are no incident reports of R1 eloping from the facility. There were no witness statements to support the allegation of resident eloped.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

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-20220317135636

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: 03/12/2024

NARRATIVE

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It was alleged that staff not following resident's care plan. Interviews revealed there were no documentation of the care plan being changed. R1's care plan shows that they will conduct their own showers on Monday, Wednesday and Fridays. After a records review, there was no documentation that showed the facility was not following the care plan. The care plan and physicians report dated 11/22/2021 stated that R1 was able to bathe and dress and handle toileting needs. There were no witness statements to support the allegation that staff not following resident's care plan.

It was alleged that staff did not notice resident's change in condition. Interviews revealed that R2 was sick. Interviews revealed that R2 was tested for Covid and received a negative test. R2's condition did not change, R2 had a cold and the staff followed all protocols and made sure the resident was taken care of and tested. The resident received meals in their room and although they were not positive for covid they treated this incident as such and R2 was isolated as if they were covid positive. There were no witness statements to support the allegation that staff did not notice resident's change in condition.

The allegations of resident eloped, staff not following resident's care plan and
staff did not notice resident's change in condition were therefore determined to be unsubstantiated, since the preponderance of evidence standard was not met.

An exit interview was conducted with Jose "Joey" Collado, Executive Director
& Amy Salvador Resident Service Director A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided and their signature on this report confirms receipt of the Licensee Rights.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC9099 (FAS) - (06/04)

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