374604063-1-31-2023-08-AS-JRAE-CNNS9Q-20230202124106

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604063
Report Date: 01/31/2023
Date Signed: 01/31/2023 01:52:57 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
12/28/2022 and conducted by Evaluator Renita Hall

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20221228081534

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:	01/31/2023
		UNANNOUNCED	TIME BEGAN:	01:43 PM
MET WITH:	Genoveva Guerrero, Director		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff did not ensure resident was provided proper assistance with food service
Resident sustained injuries due to staff not assisting resident
Staff did not notify residents representative of the unusual incident

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Renita Hall (LPA) conducted an unannounced complaint visit to investigate the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with the Director to discuss the purpose of the visit.

A records review and Licensee interview revealed the alleged victim is residing in an Independent Living facility with a different address and not licensed by the Department. The San Diego Regional Office (SDRO) Community Care Licensing (CCL) Division does not have jurisdiction over Independent Living Facilities(ILF), therefore the above allegations are determined to be Unfounded, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with the Director and a copy of this report and Licensee Appeal Rights (LIC 9058) have been given for facility records.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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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