374604063-10-27-2023-08-AS-DPOL-CX5MUY-20231031095555

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604063
Report Date: 10/27/2023
Date Signed: 10/27/2023 11:19:00 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
04/18/2023 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20230418153202

FACILITY NAME:	MESAVIEW SENIOR ASSISTED LIVING		FACILITY NUMBER:	374604063
ADMINISTRATOR:	GENOVEVA GUERRERO		FACILITY TYPE:	740
ADDRESS:	7971 CULOWEE STREET		TELEPHONE:	(619) 466-0253
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	30	CENSUS: 28	DATE:	10/27/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Ileana Castro Vazquez, Assistant Manager		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Facility is not providing meals to resident
Facililty is not providing medications to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit regarding the above-mentioned allegations to deliver findings. LPA was allowed entry by Ileana Castro Vazquez, Assistant Manager. LPA identified herself and disclosed the purpose of the visit with the Assistant Manager.

On April 18, 2023, the Department received allegations that the facility in question failed to provide medications and meals to a resident.

The resident in question was interviewed to gather information regarding the allegations. The resident denied any issues with medication or meal provision. They stated that they have been receiving their medications as prescribed and have been provided with meals regularly provided with often times meals being delivered to their rooms. The resident received all scheduled meals and snacks, with no documented instances of missed meals.

Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

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-20230418153202

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: MESAVIEW SENIOR ASSISTED LIVING	FACILITY NUMBER: 374604063
	VISIT DATE: 10/27/2023

NARRATIVE

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Multiple staff members were interviewed to ascertain the accuracy of the allegations. All staff members denied any knowledge of the facility failing to provide medications or meals to the resident. They confirmed that the facility has protocols in place to ensure medication administration and meal provision.

Medication Administration Records: The resident's medication administration records were reviewed. The records indicated that medications were consistently administered as prescribed, with no documented issues or missed doses.

The facility's environment was observed during the investigation. It was noted that the facility had a medication cart, indicating the availability of medications for residents. The dining area was also observed to be clean and well-maintained, with staff actively serving meals to residents.

Based on the interviews conducted, review of medical records, and observation of the facility, the allegations that the facility failed to provide medications and meals to the resident were found to be Unsubstantiated. The resident confirmed receiving medications as prescribed and the resident received all scheduled meals and snacks, with no documented instances of missed meals. A finding that is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with Ileana Castro Vazquez, Assistant Manager. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Assistant Manager and her signature on this report confirms receipt of the Licensee Rights.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

LIC9099 (FAS) - (06/04)

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