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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604198
Report Date: 01/23/2024
Date Signed: 01/23/2024 02:01:42 PM


Document Has Been Signed on 01/23/2024 02:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA



FACILITY NAME:VISTA GARDENSFACILITY NUMBER:
374604198
ADMINISTRATOR:SANCHEZ, PAZ HILDAFACILITY TYPE:
740
ADDRESS:1863 DEVON PLACETELEPHONE:
(760) 295-3900
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:99CENSUS: 60DATE:
01/23/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:03 PM
MET WITH:Rachel McIntyre, Health and Wellness DirectorTIME COMPLETED:
02:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced visit to deliver findings and in conjunction conduct this case management visit regarding infection control protocols. LPA identified herself and was granted entry by Cindy Jimenez, receptionist. LPA stated the purpose of the visit and reviewed the elements of the case management visit with Health and Wellness DIrector Rachel McIntyre.

The Department’s investigation of complaint dated May 4, 2020, concluded additional protocols were not followed by the facility staff. Based on records review of relevant documents pertinent to the investigation of said date, it was determined that the facility did not follow their own Infection Control 17 protocols within their plan of operation for clostridioides difficile (C-Diff).

Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during the initial investigation, and records reviewed, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC809-D.

The report was discussed, plan of correction was jointly developed and an exit interview was conducted with Health and Wellness Director Rachel McIntyre. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) were provided to Health and Wellness Director McIntyre at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/23/2024 02:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA


FACILITY NAME: VISTA GARDENS
FACILITY NUMBER: 374604198

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2024
Section Cited
CCR
87470(b)(1)

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87470 Infection Control (b)(1) In addition to the requirements of subsection (a)(2), assigned staff and volunteers, regardless of having direct contact with residents, shall be required to perform enhanced environmental cleaning and disinfection to maintain a safe and sanitary environment and to prevent, contain, and mitigate the transmission of the contagious disease.… this requirement was not met as evidenced by:
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The facility will be conducting infection control training with their floor staff to include caregivers, med tech's, LVN's, Wait saff, Housekeeping, and activities staff by POC due date, 02/09/2024. Facility will send their training documents via email to LPA by POC due date.
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Based on records review, the Licensee did not follow the infection control protocols which posed a potential health risk to 1 [R1] of 72 residents in care.
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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: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2024
LIC809 (FAS) - (06/04)
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