374604033-1-11-2023-18-AS-DMUN-CN6UER-20230117143133

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604033
Report Date: 01/11/2023
Date Signed: 01/11/2023 01:50:02 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/20/2022 and conducted by Evaluator Chinwe Nwogene

COMPLAINT CONTROL NUMBER: 18-AS-20220720111926

FACILITY NAME:	GRAND VILLA 2		FACILITY NUMBER:	374604033
ADMINISTRATOR:	MALCHOW, LAURA		FACILITY TYPE:	740
ADDRESS:	1995 SUNSET DRIVE		TELEPHONE:	(858) 231-3933
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92025
CAPACITY:	0	CENSUS: 0	DATE:	01/11/2023
		UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Laura Malchow, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff mismanaged resident medications.
Staff are not available to residents for assistance at night.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Chinwe Nwogene conducted an unannounced visit to conclude the complaint investigation into the allegation listed above. LPA met with Administrator, Laura Malchow and explained the purpose of the visit. During the investigation LPA Nwogene interviewed staff, interviewed Hospice Nurse, reviewed resident file and facility records.
Regarding the allegation “Staff mismanaged resident medications”. LPA interviewed staff who stated resident’s medication is administered to resident daily. LPA requested for resident medication records. Administrator, Laura Malchow stated Administrator doesn't have resident’s medication records and doesn't remember what and when the medications were administered.
Regarding the allegation “Staff are not available to residents for assistance at night”. It was alleged staff is not available to resident at night because staff was sleep. LPA’s interview with resident revealed resident only yells help when resident needs assistance, making it hard to get help from staff when staff is sleeping at night. LPA interviewed Administrator, Laura Malchow who stated facility has staff 24hrs a day but facility is not a 24hrs care facility.
Based on LPA’s interviews and record review the preponderance of evidence standard has been met. Therefore, the above allegations are found to be substantiated. California Code of Regulations (Title 22, Division & Chapter number 6) are being cited on the attached LIC9099D). An exit interview was conducted, and a copy of this report was reviewed and provided along with appeal rights to Laura Malchow.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

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 4

Control Number 18-AS-20220720111926

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: GRAND VILLA 2	FACILITY NUMBER: 374604033
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/11/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/20/2023 Section Cited CCR 87465(a)(6)	1 2 3 4 5 6 7	Incidental Medical and Dental Care; When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.	1 2 3 4 5 6 7	According to Administrator, Laura Malchow moving forward facility will maintain residents medication record in residents file.
	8 9 10 11 12 13 14	This requirement is not met based as evidence by interview. The licensee did not comply by not maintaining resident's medication records which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
Type B 01/20/2023 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	Personnel Requirements - General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.	1 2 3 4 5 6 7	According to Administrator, Laura Malchaw moving forward staff will be available for residents at night.
	8 9 10 11 12 13 14	This requirement is not met based as evidence by interview. The licensee did not comply by not staff available to meet resident's needs at night which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14

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: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/20/2022 and conducted by Evaluator Chinwe Nwogene

COMPLAINT CONTROL NUMBER: 18-AS-20220720111926

FACILITY NAME:	GRAND VILLA 2		FACILITY NUMBER:	374604033
ADMINISTRATOR:	MALCHOW, LAURA		FACILITY TYPE:	740
ADDRESS:	1995 SUNSET DRIVE		TELEPHONE:	(858) 231-3933
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92025
CAPACITY:	0	CENSUS: 0	DATE:	01/11/2023
		UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Laura Malchow, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff force fed resident.
Staff administered medication to resident in a forceful manner.
Resident sustained open bedsores because staff did not adequately care for resident.
Staff did not keep the facility free from ants.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 18-AS-20220720111926

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: GRAND VILLA 2	FACILITY NUMBER: 374604033
	VISIT DATE: 01/11/2023

NARRATIVE

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Continued from LIC9099

Regarding the allegation “Resident sustained open bedsores because staff did not adequately care for resident”. LPA Interviewed Administrator, Laura Malchow who stated resident was bedridden and might have developed bedsore from having thin skin and being bedridden. Laura also stated staff turned and repositioned resident regularly. Resident’s file review revealed resident was not bedridden however resident couldn’t walk and was using hospital bed with full rails and wheelchair. Interview with Hospice nurse revealed due to resident's age, resident always on wheelchair or bed could contribute to resident developing a bedsore.

Regarding the allegation “Staff did not keep the facility free from ants”. It was alleged ants was found crawling on resident. LPA interviewed staff who acknowledged to have found ants on resident’s bed. Administrator, Laura Malchow stated non-poison ant powder and ant traps was bought and immediately took care of the ants. LPA’s interview with Hospice nurse revealed ants was found once on resident’s bed but was immediately taken care of by the facility. LPA conducted an inspection of the facility and observed no ants.

Based on LPA’s interviews, facility inspection conducted, reviewed of resident records there is not enough evidence to support above allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Laura Malchow.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4