374604063-12-16-2021-08-AS-SJAB-CA8M9W-20211231082523

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604063
Report Date: 12/15/2021
Date Signed: 12/16/2021 09:42:02 AM

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
04/14/2020 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20200414105231

FACILITY NAME:	MESAVIEW SENIOR ASSISTED LIVING		FACILITY NUMBER:	374604063
ADMINISTRATOR:	SETTINERI, JEFFREY		FACILITY TYPE:	740
ADDRESS:	7971 CULOWEE STREET		TELEPHONE:	(619) 379-0234
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	30	CENSUS: 29	DATE:	12/15/2021
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Med Tech Jazmine Aguirre		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Lack of supervision resulting in resident wandering from facility.
Facility staff did not report missing resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above listed complaint allegations. LPA Correia met with Med Tech Jazmine Aguirre to whom was explained the purpose for the visit.

The Department’s investigation consisted of staff, and outside source interviews, and facility and resident record reviews.

It was alleged that Resident (R1) went AWOL due to lack of supervision. R1 is 82 years old and had lived at the facility approximately 11 months. A record review revealed R1 is diagnosed with Dementia and has a history of wandering. Facility staff were required to conduct resident checks every 30 minutes and provide significant redirection thought the day and night.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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-20200414105231

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: 12/15/2021

NARRATIVE

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Staff interviews and a record review revealed on April 11, 2020 at approximately 3:00 pm facility staff1(S1) was conducting resident checks and was not able to locate R1. S1 immediately notified facility staff2 (S2) and began searching the community. The facility Administrator notified R1’s Responsible Party(RP) and the La Mesa Police Department (LMPD). Additional interviews revealed S2 last saw R1 at approximately 2:20 pm. in the facility lobby. At that time, R1 seemed agitated so S2 re-directed R1 back to their room. A record review revealed at 3:06pm R1 was located by the LMPD a block away and was brought back to the facility at approximately 3:15pm.

It was also alleged facility staff did not report the missing resident per regulation. A record review revealed Facility staff reported all the appropriate parties meeting Title 22 mandate.

Based on interviews conducted and pertinent records reviewed, it was determined the above allegations were determined to be unsubstantiated. An unsubstantiated finding means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred. There were no deficiencies cited during today’s visit.

An exit interview was conducted with Med Tech Jazmine Aguirre and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to Med Tech Jazmine Aguirre via email. An electronic email read receipt confirms the documents were received.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC9099 (FAS) - (06/04)

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