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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603750
Report Date: 03/26/2024
Date Signed: 03/27/2024 10:00:54 AM

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
08/31/2022 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20220831154817
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: 62DATE:
03/26/2024
UNANNOUNCEDTIME BEGAN:
04:38 PM
MET WITH:Memory Care Director, Marie Lou FikingasTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff tampered with resident's personal belongings.
Resident was not provided with safe equipment.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the complaint investigation regarding the above mentioned allegations. LPA met with Executive Director, Jose Collado Jr. and Memory Care Director, Marie Lou Fikingas.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff and outside sources. It was alleged that staff tampered with Resident #1’s (R1) personal belongings, involving their laptop. R1 had a laptop in their room with an active camera, which was used for Zoom calls with their family. One day a medication technician went to R1’s room to dispense medications and observed themselves on the camera as though it was being recorded. The medication technician left the room and reported the camera to the Executive Director (ED). The ED went to R1’s room to verify if the camera was in use. The ED confirmed the facility does not have cameras in the building as they prefer staff and residents to have privacy. When the ED arrived at R1’s room they saw themselves on the camera as well as being recorded. The ED’s interview revealed that he asked R1 if it was okay to cover the camera for privacy, as there was a sticky note hanging on the laptop near the camera. Continued on an LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
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 5
Control Number 08-AS-20220831154817
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: 03/26/2024
NARRATIVE
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The ED used the sticky note and covered the camera with R1’s permission. R1’s Physician Report dated 11/22/01 indicated a diagnosis of Major Neurocognitive Disorder, and was confused and disoriented, and unable to leave the facility unassisted. Due to R1’s diagnosis it’s unknown if R1 understood the camera was being covered.

Outside source interviews confirmed R1 did not know how to operate the laptop due to their medical diagnosis. Outside sources stated the camera was always on so that the family could contact R1, since R1 didn’t know how to operate it. Additional outside sources revealed the facility did not have consent to cover the camera on the laptop, as that was how the family communicated with R1. When the family tried to contact R1 via camera on the laptop they were unable, due to the camera being covered. Therefore, the family member went to the facility and discovered a piece of tape was placed over the camera. Due to R1’s medical diagnosis and not being able to provide consent, the facility needed to discuss the issue with the responsible party prior to covering the camera. The ED explained the staff were uncomfortable being recorded and didn’t want to provide medications. Therefore, he asked R1 for consent to ensure staff felt their privacy was protected.

It was also alleged, a resident was not provided with safe equipment. R1 was provided with a wander guard bracelet that alarms if R1 exits the building. The safety feature was in place due to R1’s medical diagnosis and not residing in the locked memory care unit. The wander guard does not prevent a resident from eloping but alerts staff so they may intervene. According to staff, if R1 exited the building, a notification was sent to the staff’s iPad, a notification to the concierge, and a loud sounding alarm for all to hear. Staff interviews confirmed R1’s wander guard was inoperable but for an unknown time. A review of correspondences indicated the facility was made aware of the inoperable equipment on 02/12/22 and the facility responded on 02/14/22 stating a new wander guard was requested, and being programmed, they will cut the existing one off and replace it. On 02/15/22, R1’s family member was visiting R1 when a staff member entered the room to replace the inoperable wander guard. The wander guard was inoperable for approximately three (3) days, which was unsafe for R1 due to their medical diagnosis.

Based on interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8, are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Memory Care Director, Marie Lou Fikingaswhose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20220831154817
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: 03/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/09/2024
Section Cited
CCR
87468.1(a)(1)
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Personal Rights of Residents in All Facilities. Residents in...facilities...shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:
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Executive Director agreed to attend Personal Rights training regarding treating residents with dignity and provide proof of training by POC due date.
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Based on interviews the licensee did not accord dignity to 1 out of 71 residents [R1] when they covered R1’s laptop camera, which posed a potential safety and/or personal rights to residents in care.

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Type B
04/09/2024
Section Cited
CCR
87468.1(a)(2)
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Personal Rights of Residents in All Facilities. Residents...facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by:
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Executive Director agreed to attend Personal Rights training regarding safe equipment for residents and provide proof of training by POC due date.
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This requirement is not met as evidenced by: Based on interviews the licensee did not ensure resident’s safety equipment was operable for 1 out of 71 residents [R1] due to the wander guard being inoperable for approximately three
days, which posed a potential safety and/or personal rights to 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: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
08/31/2022 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20220831154817

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: 62DATE:
03/26/2024
UNANNOUNCEDTIME BEGAN:
04:38 PM
MET WITH:Memory Care Director, Marie Lou FikingasTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility withheld resident's medical records
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the complaint investigation regarding the above mentioned allegations. LPA met with Executive Director, Jose Collado Jr. and Memory Care Director, Marie Lou Fikingas.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff and outside sources. It was alleged that the facility withheld a resident's medical records. It was reported Resident #1’s (R1) responsible party requested a copy of R1’s Medication Administration Records (MARs). Resident Services Director’s (RSD) interview revealed they were new to the facility and still learning the computer systems when the MARs was requested. Per the RSD they explained to the responsible party they had to figure out how to access the documents and would provide it. RSD stated it took less than two (2) days for her to learn how to access the MARs, then she provided it to the responsible party. RSD also stated
the Ombudsman was present when the MARs was provided to the responsible party. The responsible party confirmed the MARs was provided and the Ombudsman was present. Continued on an LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20220831154817
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: 03/26/2024
NARRATIVE
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During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) was provided to Memory Care Director, Marie Lou Fikingas whose signature below confirms receipt of these rights.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5