374604176-10-9-2024-18-AS-TDAN-DB9P6A-20241122100202

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604176
Report Date: 10/09/2024
Date Signed: 10/09/2024 02:45:56 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/09/2024 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240709091545

FACILITY NAME:	ALTA VISTA SENIOR LIVING		FACILITY NUMBER:	374604176
ADMINISTRATOR:	ALSPACH, DAVID		FACILITY TYPE:	740
ADDRESS:	2041 W VISTA WAY		TELEPHONE:	(760) 941-3233
CITY:	VISTA	STATE: CA	ZIP CODE:	92083
CAPACITY:	98	CENSUS: 80	DATE:	10/09/2024
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Jennnifer Gephart, Executive Director		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Staff did not ensure that the facility was in good repair
Staff did not provide a safe environment.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegations listed above. LPA met with Jennifer Gephart, Executive Director and explained the purpose of the visit and the elements of the allegations. The allegations were investigated, and the investigation consisted of observations, interviews and records review. On 07/09/2024 Community Care Licensing received a complaint alleging that staff did not ensure that the facility was in good repair and that staff did not provide a safe environment.

Regarding the allegation of staff did not ensure that the facility was in good repair. It was alleged that there were two gates that were disabled/out of service, which poses a safety risk since anyone can enter or leave the facility. On 07/12/24 the initial complaint visit was conducted, and LPA observed for there to be 2 gates in the back of the property. However, only one was observed to be out of service. Both of the gates required a code to enter, however the electronic/locking function was disabled and would not engage, on the gate that is facing towards the facility garage.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 217-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

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 18-AS-20240709091545

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ALTA VISTA SENIOR LIVING	FACILITY NUMBER: 374604176
	VISIT DATE: 10/09/2024

NARRATIVE

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As a result, LPA observed for facility staff to be utilizing a red and black band that was adjusted with a silver clamp to hold the band in place that would assist with keeping the gate closed. Per interview with the Business Office Manager the facility was in the process of getting quotes to repair the gate. LPA requested copies of the quotes but were not received. LPA followed up on 07/16/24 in regards to the status of the gate repair, and was informed that the facility was still in the process of obtaining quotes. On 09/30/24 LPA conducted a follow up visit and observed for the gate to have been repaired and the code entry mechanism to be functioning properly. Based on observation and interviews the allegation of staff did not ensure the facility was in good repair is substantiated.

Staff did not provide a safe environment.

It was alleged that a door in memory care was not functioning properly (locking) as the locked door was to assist with preventing memory care residents from leaving out of the designated areas, and the electronic function was not working on the door. LPA observed for said door to be working properly at the time that the visit was conducted on 07/12/24. However, through further investigation of a conducted records review revealed that on 06/27/24 Resident #1 (R1) was able to successfully exit out of the facility. Local law enforcement had to respond to the facility and was able to successfully locate R1 in another building. R1 was said to have entered into the bedroom of another resident and walked out onto their patio, walked down the pathway and exit through the gate that was disarmed and not functioning/locking properly. Per an interview with Memory Care Director Jenna Lazaga R1 did not obtain any injuries and as a result the eloping incident the facility implemented two-hour safety checks. Based on interviews and records review the allegation of staff did not provide a safe environment is substantiated. An allegation that is substantiated means a finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted and a copy of this report, appeal rights, LIC811-confidential names list and LIC9098-Proof of corrections form was reviewed and provided to Executive Director Jennifer Gephart.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 217-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20240709091545

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ALTA VISTA SENIOR LIVING	FACILITY NUMBER: 374604176
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/09/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/23/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met	1 2 3 4 5 6 7	There is no POC due at this time, as the gate was officially repaired on 09/27/24.
	8 9 10 11 12 13 14	as evidenced by: the licensee did not ensure that the facility gate was in good repair, which posed a potential health, safety and personal rights risk to persons in care.	8 9 10 11 12 13 14
Type B 10/23/2024 Section Cited CCR 87307(d)(2)	1 2 3 4 5 6 7	87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.	1 2 3 4 5 6 7	The licensee agrees to conduct an inservice on elopment and, safety checks. Proof of POC is to be submitted to the department by 5pm on the due date indicated.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by the licensee did not ensure that the premises was maintained in safe and healthful environment. Which posed a potential health, safety and personal rights risk to persons in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 217-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

LIC9099 (FAS) - (06/04)

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