374604063-7-21-2022-08-AS-LTEZ-CGRU88-20220728152104

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604063
Report Date: 07/21/2022
Date Signed: 07/21/2022 07:11:21 PM

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
11/10/2021 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20211110155911

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:	07/21/2022
		UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Administrator Genoveva Guerrero		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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-Licensee kept resident at the facility, against their will.
-Licensee did not enable resident choice/decision regarding care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit, to deliver findings regarding the above prior complaint allegations. LPA was welcomed by and identified himself to Med Tech Fabiola Reyes. LPA then met with and discussed the purpose of the visit with Administrator Genoveva Guerrero, who arrived later during the visit.

It was alleged that licensee did not allow Resident #1 (R1) to move out of the facility per their will, after their spouse/power-of-attorney (POA) conspired with their physician to have R1 inaccurately diagnosed with dementia. It was further alleged that licensee did not enable R1 choice in the planning of their care, because licensee contacted R1’s third-party, home health agency (HHA), without R1’s consent or involvement, to request a change in the agency personnel assigned to R1’s care. CCLD’s investigation consisted of an unannounced facility tour/welfare check, review of pertinent care and medical records on R1, and interview of R1, their spouse/POA, and pertinent facility and HHA staff. [CONTINUED ON LIC 9099-C, 1 of 2]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

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-20211110155911

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: 07/21/2022

NARRATIVE

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[CONTINUED FROM LIC 9099] With respect to the first allegation, the premise that R1 wanted to move out of the facility, is itself uncertain. Based on LPA observations, R1 appeared alert and oriented with no apparent memory loss. However, cognitive impairment is not a pre-requisite for living in a Residential Care Facility for the Elderly (RCFE) setting. R1 themselves admitted that they are diabetic, blind in one eye, use a walker, and need staff help with showering. (These were corroborated by R1’s LIC602 Physician’s Report and R1’s spouse/POA. According to R1’s physician and the facility plan of care, R1 also needed hands-on help with dressing, bathroom use, and medication management). R1 admitted to not knowing where they would go if they moved out of the facility, and not knowing how their needs would be met. R1 later said if were not at their current RCFE, they imagine they would be living at assisted living facility in Minnesota, near their son (but even this was something that R1 had not yet researched). R1 revealed that they did not object to living at Mesaview Senior Assisted Living per se, but rather desired more communication from their spouse/POA about their finances. The Department concluded that while R1 was homesick, they did not have a concrete plan or intent to leave the facility (which the licensee could have somehow blocked). It was further revealed that licensee met reporting requirements in support of R1’s personal rights. Seven months before this complaint was filed, and in response to R1’s verbalizations that their spouse/POA placed them in the facility against their will, licensee submitted an LIC624 Unusual Incident Report and an SOC341 Report of Suspected Dependent Adult/Elder Abuse form to CCLD and the San Diego County Long Term Care Ombudsman. According to available information, San Diego County Adult Protective Services (APS) had jurisdiction and investigated the matter. (To date, there has been no change to either R1’s residency at the facility, or their spouse’s status as their POA.)

Regarding the second allegation, it was revealed that licensee themselves did not violate R1’s right to make decisions regarding their own care. Interviews of facility staff revealed that in early 2021, licensee indeed contacted a manager at the home health agency about insufficient communication between their staff to facility staff. However, licensee did not request that any personnel assignments be changed/replaced. Meanwhile, in their own interview, R1’s spouse/POA said they had concerns about the professionalism of a particular HHA staff, and thus called the agency and explicitly requested a change in who was assigned to R1. They added, “[The HHA manager] assured me it would not happen again, but it did happen again.” The spouse/POA’s memory of specific details was faded, but their statements implied that even if additional rounds of HHA staffing changes occurred, it was likely that the spouse/POA (and not the licensee) was the catalyst for them. The evidence does not show licensee bore culpability for changes in R1’s assigned HHA staff, even if such changes greatly upset R1. [CONTINUED ON LIC 9099-C, 2 of 2]

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 08-AS-20211110155911

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: 07/21/2022

NARRATIVE

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[CONTINUE FROM LIC 9099-C, 1 of 2]

Based on interviews and records, a preponderance of evidence does not exist to support the allegations that licensee violated R1’s personal rights, with respect to either stopping R1 from moving out or preventing them from making decisions regarding their own care. Both allegations are therefore unsubstantiated. An exit interview was conducted with Guerrero, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

LIC9099 (FAS) - (06/04)

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