374604155-6-17-2021-08-AS-IESA-C5FV8F-20210731161241

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604155
Report Date: 06/17/2021
Date Signed: 06/17/2021 03:10:38 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
03/18/2020 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20200318094837

FACILITY NAME:	GOLDEN VISTA MANOR		FACILITY NUMBER:	374604155
ADMINISTRATOR:	CASTELLANOS, JENNY		FACILITY TYPE:	740
ADDRESS:	2590 MAJELLA RD		TELEPHONE:	(760) 216-6344
CITY:	VISTA	STATE: CA	ZIP CODE:	92084
CAPACITY:	12	CENSUS: 0	DATE:	06/17/2021
		UNANNOUNCED	TIME BEGAN:	01:37 PM
MET WITH:	Sent Via Certified Mail to Last Known Address		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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- Staff slapped resident while in care.
- Staff threw resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Lopez sent this report to the former licensee's last known mailing address via USPS certified mail to deliver the investigation findings for the above allegations. This facility ceased operations on October 28, 2020.

The Department’s investigation included records review, interviews with residents, staff and outside sources.

It was reported to Community Care Licensing that a facility staff member slapped and threw a resident in care. According to a witness, sometime in mid-2019, possibly in the month of May or June 2019, Staff #1 was seen slapping Resident #1 (R1), on the right side of the face. R1 kicked S1 so S1 slapped R1 in retaliation. A review of R1’s physician’s report revealed R1 is diagnosed with dementia and was noted to be disoriented and confused but is able to communicate their needs. In addition, the document notes that R1 has aggressive behaviors.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

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-20200318094837

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: GOLDEN VISTA MANOR	FACILITY NUMBER: 374604155
	VISIT DATE: 06/17/2021

NARRATIVE

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Per staff records reviewed, S1 has worked at the facility since February 2019. During staff interviews, it was reported that S1 does become agitated with residents, but no physical mistreatment was reported to have been seen.

Interviews with residents revealed that residents have heard staff raise their voices at other residents in a stern way. It was noted that residents have experienced staff yelling at resident and others described staff as not being nice. No physical abuse was reported during the interviews and no additional information was provided. LPA attempted to conduct an interview with R1, but R1 declined.

Interviews with outside sources revealed that there have been no issues reported or witnessed to indicate physical abuse from staff towards the residents.

An interview with former Administrator confirmed that S1 have verbally abused residents in the past. Former Administrator advised that S1 did admit to cursing at R2. Administrator advised that the facility’s course of action taken towards S1's was a written reprimand. However, a review of S1 file did not produce the document.

During the interview, S1 did confirm using only minor force with R1 to ensure resident did not become physically aggressive with staff. Minor force was described as S1 holding R1’s hand down while S2 held the other hand. S1 denied physically or verbally abusing residents. A review of S1’s training documents, S1 was not formally trained in conducting restraints.

Based on interviews and records reviewed, the investigation did not produce corroborating evidence to meet the preponderance of evidence standard; therefore, the allegations are found UNSUBSTANTIATED.

A copy of this report and appeals rights (LIC 9058 1/16) were sent to the licensee's last known address via USPS certified mail due to facility closure.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

LIC9099 (FAS) - (06/04)

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