374604198-3-15-2023-18-AS-JESL-CQF862-20230330221337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604198
Report Date: 03/15/2023
Date Signed: 03/15/2023 12:20:48 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/01/2022 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220401122853

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: 79	DATE:	03/15/2023
		UNANNOUNCED	TIME BEGAN:	11:44 AM
MET WITH:	Hilda Paz, Executive Director and Rachel McIntyre,RSD		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Resident sustained an unexplained injury while in care
Staff did not safeguard resident's personal items

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Javina George and Janira Arreola made an unannounced visit to the facility to investigate a deliver findings for the allegations (s) listed above. LPA met with Executive Director Hilda Paz and Rachel McIntyre,RSD. LPA explained the purpose of the visit and elements of the allegations. The investigation consisted of observation, interviews, and record review.

Resident sustained an unexplained injury while in care
Regarding the allegation of “Resident sustained an unexplained injury while in care”, LPA reviewed documentation that notes reveals Resident #1 (R1) to have had a tear on their ring finger as evidenced by there was a steri strip. However, there was nothing noted in the hospice notes or any other documentation reviewed such as R1 requiring first aid R1 for a cut to their finger. It was noted that R1 had several cuts on wounds on their forearm, and wrists. The cause of the alleged cut on R1’s finger could not be identified. There is not sufficient evidence to support that resident had an unexplained injury in care. The allegation of resident sustained an unexplained injury while in care is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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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Control Number 18-AS-20220401122853

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: VISTA GARDENS	FACILITY NUMBER: 374604198
	VISIT DATE: 03/15/2023

NARRATIVE

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Staff did not safeguard resident's personal items

Regarding the allegation of “Staff did not safeguard resident's personal items” Resident #1 (R1) was admitted to the facility on July 26, 2018. LPA reviewed documentation that revealed that R1 was admitted to the facility with a wedding ring (no description provided), as it was noted on R1’s inventory sheet. An additional review of R1s admission agreement which includes the facility’s theft and loss procedures. The Theft and loss program states “This Facility is required by Title 22 section 87218 to notify residents upon admission of its written policies regarding the Facility's theft and loss prevention program. The State's theft and loss program, the family does not have the option of refusing to disclose items required to be inventoried at the time of admission and as brought into the Facility after admission. …San Diego Senior Services, LLC is not responsible for any cash, valuables or personal property brought into the Facility unless these items are delivered to the licensee/administrator for safeguarding. Keep all valuables at home, including dry cleaning…” Per Administrator Hilda Paz measures were taken in order to retrieve R1s wedding ring. A police report was filed, as well as an internal investigation conducted, which included agency staff that was assisting with staffing were included. There was no cause was found from the internal investigation. In addition, the facility put a reward for the wedding ring, however the attempt was not successful. . Further the ring was not given to the Licensee/Administrator to safeguard. R1s ring was last noted to be on their finger, in their possession. The allegation of staff did not safeguard resident’s personal items is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and a copy of this report and LIC 811 (confidential names list), was provided to Executive Director Hilda Paz and Rachel McIntyre, Resident Services Director

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC9099 (FAS) - (06/04)

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