374604198-10-20-2020-08-AS-IESA-BUW4YZ-20201030193159

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604198
Report Date: 10/20/2020
Date Signed: 10/20/2020 10:30:01 AM

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
12/05/2019 and conducted by Evaluator Anna Kennedy

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20191205095253

FACILITY NAME:	VISTA GARDENS		FACILITY NUMBER:	374604198
ADMINISTRATOR:	DELGADO, EVELYN		FACILITY TYPE:	740
ADDRESS:	1863 DEVON PLACE		TELEPHONE:	(760) 295-3900
CITY:	VISTA	STATE: CA	ZIP CODE:	92084
CAPACITY:	99	CENSUS: 69	DATE:	10/20/2020
		UNANNOUNCED	TIME BEGAN:	10:14 AM
MET WITH:	Rachel McIntire		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Lack of supervision resulting in residents engaging in a physical altercation

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kennedy conducted a complaint visit via a video-calling app due to COVID-19 restrictions to deliver the findings for the above allegation. LPA identified herself and stated the purpose of the video-call to Rachel McIntire, Memory Care Director.

The investigation included a tour of the facility, interviews with internal and external sources and a review of documents, including a video of the incident.

It was alleged that a lack of supervision resulted in residents engaging in a physical altercation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Anna Kennedy	TELEPHONE: (619) 997- 4108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020

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-20191205095253

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: VISTA GARDENS	FACILITY NUMBER: 374604198
	VISIT DATE: 10/20/2020

NARRATIVE

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Based on interviews and reviewing the video of the incident it was determined that there was a physical altercation between 2 residents. The incident occurred during an activity featuring a piano player entertaining the residents. Resident 1 (R1) (See LIC 811 for a list of confidential names) was seated in the front row of residents at the piano program. Several residents danced and stood up during the performance. Resident 2 (R2) was standing close to the piano player. R1 got up, took a few steps forward and spoke with R2 and then sat back down. This interaction took 21 seconds. A few minutes later R1 again got up and advanced to speak with R2, who had moved to the other side of the piano player. R1 spoke to R2 and R2 shoved R1 to the floor. R1 sustained significant injury as a result of the fall. This interaction took ten seconds from the time R1 stood up until R1 was on the floor.

Interviews and documents revealed that neither resident had any incident involving aggression while residing in the facility. R1’s care plan does not require one-on-one supervision being provided by the facility. Based on the video observations, there was not any indication that the interaction between the two residents was escalating prior to R2 shoving R1 to the floor. There was no reason, based on history, or the behavior immediately prior to the shove, for staff to intervene in the interaction between the residents. The interaction was less than ten seconds from R1 getting up and being shoved to the ground. It was also determined that, within 30 seconds of the fall, there were multiple staff members at the side of R1 assessing and assisting R1 and calling 911-emergency.

Based on records and interviews, there is not a preponderance of the evidence to determine that the incident was due to a lack of supervision, therefore, this complaint allegation is determined to be Unsubstantiated.

An exit interview was conducted with Rachel McIntire, Memory Care Director via video-call. A copy of this report along with Licensee Rights (LIC9058 01/2016) was provided to Ms. McIntire via email. An electronic response confirms the documents were received.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Anna Kennedy	TELEPHONE: (619) 997- 4108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020

LIC9099 (FAS) - (06/04)

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