374604065-10-13-2021-08-AS-SJAB-C86VDR-20211026162110

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604065
Report Date: 10/13/2021
Date Signed: 10/13/2021 04:09:27 PM

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
12/18/2020 and conducted by Evaluator Alexandre Vo

COMPLAINT CONTROL NUMBER: 08-AS-20201218163030

FACILITY NAME:	LAS VILLAS DE CARLSBAD		FACILITY NUMBER:	374604065
ADMINISTRATOR:	BLOOM, CHARLIE		FACILITY TYPE:	740
ADDRESS:	1088 LAGUNA DRIVE		TELEPHONE:	(760) 434-7116
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92008
CAPACITY:	214	CENSUS: 87	DATE:	10/13/2021
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Executive Director, Donelle Williams		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

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-Facility does not have hot water

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Alexandre Vo, conducted an unannounced complaint visit regarding the above-mentioned allegation. LPA was allowed entry into the facility after identifying himself and stating the purpose of the visit. LPA met with Executive Director, Donelle Williams, and Resident Services Director, Stephanie Ancheta, and explained the basic elements of the complaint.

The Department’s investigation included review of facility records and interview with staff. It was alleged that the facility did not have hot water. Based on review of facility records and the facility’s sketch, this is a four building premises, of which three are currently licensed by Community Care Licensing Division: Building A, Building B, and Building C. Based on the incident report received at the San Diego Regional Office regarding the maintenance issues from December 15 through 18, 2020, there was no hot water in Building B.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alexandre Vo	TELEPHONE: (619) 385-7506
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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-20201218163030

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: LAS VILLAS DE CARLSBAD	FACILITY NUMBER: 374604065
	VISIT DATE: 10/13/2021

NARRATIVE

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Interim Administrator, James Ringhoff, notified LPA Wu during their daily calls on December 15, as well as, a maintenance work order for services rendered on December 17, 2020. The facility also sent out notices to their residents during the hot water outage dated December 15, 2020. Although the water went out again on December 18, 2020, it was immediately repaired, and no further issues were reported. Water in the kitchen and laundry were unaffected and there were no health or safety concerns related to the hot water outage. Therefore, this complaint is unsubstantiated because the preponderance of the evidence standard has not been met and the facility addressed their maintenance issue.

An exit interview was conducted and a copy of this report along with the Licensee’s Rights (9058 01/16) were provided to Executive Director, Donelle Williams, via electronic mail. An e-mail receipt was requested upon the receipt of the documents.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alexandre Vo	TELEPHONE: (619) 385-7506
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

LIC9099 (FAS) - (06/04)

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