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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604063
Report Date: 11/17/2023
Date Signed: 11/21/2023 08:31:44 AM

Unsubstantiated


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
09/28/2020 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20200928154706
FACILITY NAME:MESAVIEW SENIOR ASSISTED LIVINGFACILITY NUMBER:
374604063
ADMINISTRATOR:SETTINERI, JEFFREYFACILITY TYPE:
740
ADDRESS:7971 CULOWEE STREETTELEPHONE:
(619) 379-0234
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:30CENSUS: 28DATE:
11/17/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Assistant Manager, Ileana CastroTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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-Licensee did not meet the needs of a resident, resulting in dehydration
-Staff are retaliating against the resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the investigation regarding the above mentioned allegations. LPA met with Assistant Manager, Ileana Castro.

During the investigation, records were reviewed, and interviews were conducted with staff and outside sources. It was alleged that the licensee did not meet the needs of Resident #1(R1), resulting in dehydration. R1’s Physician’s Report dated 11/19/19 indicated R1 had a Major Neurocognitive Disorder, Ambulatory but uses an assistive device, and able to dress/groom, toilet and feed themselves. R1’s Resident Appraisal dated 07/20/20 indicated services needed with transfers, bathing, dressing/grooming, help with moving about the facility, reminders with eating, toileting, medication management, and night supervision needed for fall risk, and wandering. It also indicated R1 refuses assistance with those services needed. R1’s medical records reflected on 10/04/20 R1 was transported to the hospital and diagnosed with dehydration and fecal impaction and returned to the facility the same day. Continued on the 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: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
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-20200928154706
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: MESAVIEW SENIOR ASSISTED LIVING
FACILITY NUMBER: 374604063
VISIT DATE: 11/17/2023
NARRATIVE
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Outside source interviews revealed R1 reported they are drinking 3 oz of water daily. The outside source confirmed R1 was forgetful due to their medical condition but able to determine if they drank water, just not the accurate amounts. The facility’s Hydration Log dated 09/21/20 through 10/07/20 confirmed R1 was drinking water, coffee, milk and refusing fluids on multiple occasions. Staff interviews confirmed R1 was offered water multiple times a day but refused at times and requested milk or coffee. Further staff interviews revealed two (2) bottles of water were kept on R1’s night stand next to their bed and R1 was capable of drinking on their own.

It was also alleged staff are retaliating against R1. It was reported staff are calling 911 for R1, which was unnecessary and costly, and not allowing visitation. Outside source interviews revealed it’s costly when the facility contacts 911 for R1. Outside sources also indicated they believe it was unnecessary and the facility was purposely contacting 911 so that R1 will incur costs. Staff interviews showed its facility policy if a resident complains of pain, hits their head and/or does not look well, they ensure the resident receives timely medical attention. On 09/28/20, R1 reported to staff they were not feeling well and very weak. Staff observed R1 was having difficulty bearing weight, so they had R1 sit down under the covered patio area and offered R1 a cup of water. The staff also recorded a video of R1 appearing lethargic and encouraging R1 to drink water. The facility provided R1’s responsible party with the video to show R1 was not well and required medical attention. Staff interviews revealed R1’s responsible party did not agree R1 required medical attention after reviewing the video. Outside source interviews identified R1’s responsible party believed staff should have placed R1 in an air-conditioned room and provided R1 with water, instead of contacting 911. Staff interviews confirmed R1 was in an air-conditioned room for many hours and provided water. Staff felt it necessary to send R1 out for evaluation as a precaution and ensure they meet R1’s needs. R1 was diagnosed at the hospital with dehydration. Therefore, the medical visit was necessary and not for retaliation purposes.

Facility visitations were restricted during Covid-19 Pandemic. The facility had a visitation area that was enclosed, which allowed for only one (1) resident to visit their visitor at a time. A visitor came to visit R1 but R1 refused the visit. Also, one evening a visitor was visiting a resident when another visitor wanted to visit with another resident. However, the covid 19 restrictions for the facility allowed only one (1) visitor, which upset the other visitor. The visitor was not told they cannot visit, just needed to wait their turn. The facility followed Covid-19 visitation requirements. Continued on an LIC 9099C.

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

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20200928154706
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: MESAVIEW SENIOR ASSISTED LIVING
FACILITY NUMBER: 374604063
VISIT DATE: 11/17/2023
NARRATIVE
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During 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 allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Assistant Manager, Ileana Castro whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3