374604198-10-27-2020-08-AS-IESA-BUWVWL-20201031164808

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604198
Report Date: 10/27/2020
Date Signed: 10/27/2020 11:55:30 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
03/04/2020 and conducted by Evaluator Jonathan C Pineda

COMPLAINT CONTROL NUMBER: 08-AS-20200304101853

FACILITY NAME:	VISTA GARDENS		FACILITY NUMBER:	374604198
ADMINISTRATOR:	HUNDLEY, SHANNON		FACILITY TYPE:	740
ADDRESS:	1863 DEVON PLACE		TELEPHONE:	(760) 295-3900
CITY:	VISTA	STATE: CA	ZIP CODE:	92084
CAPACITY:	99	CENSUS: 70	DATE:	10/27/2020
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Evelyn Delgado, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff are not preventing the spread of communicable disease(s) within the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jonathan Pineda conducted an unannounced complaint tele-visit to deliver findings on the above allegations. LPA identified himself and stated the purpose of the call. LPA spoke with Evelyn Delgado, Administrator.
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The Department's investigation consisted observations, interviews, record review, and outside sources.

It was alleged that are not preventing the spread of communicable disease(s) within the facility. Investigation revealed that Resident 1, R1 (See Confidential Names List) left the facility on 3/3/20 with their responsible party for an unrelated health condition. On 3/3/20, facility staff was notified by telephone by an outside source advising that R1 tested positive for Clostridium Difficile (C-DFF). Facility staff advised that resident cannot come back to the facility without clearance from a doctor that R1 is negative for C-DFF. At the time of the phone call, R1 was out of the community with their responsible party getting labs done at the hospital.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Girolami	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Jonathan C Pineda	TELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020

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-20200304101853

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: 10/27/2020

NARRATIVE

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At approximately 11:00pm hospital staff called the facility stating that R1 was being discharged back to the community. Hospital staff advised they would send the documentation requested. On 3/4/20 at approximately 1:30am R1 returned to the facility by private car with their responsible party. R1’s responsible party did not bring any discharge paperwork proving that R1 tested negative for C-DFF. Per facility’s Infection Control policy dated 7/22/19, R1 was not retained and sent to the hospital for further evaluation and treatment on 3/4/2020. Investigation revealed the facility deep cleaned R1’s room using antibacterial cleaning solution provided by Ecolab. All common areas were cleaned per normal activity, handrails, and armchairs. All of R1’s clothing and bedding were washed in hot water. Interview and record review revealed facility held an in-service with facility staff dated on 3/10/20 discussing how to prevent the spread of C-DFF.

The Department investigated allegations that staff failed staff are not preventing the spread of communicable disease(s) within the facility. Based on observations, review of records, and interviews, it is determined that the allegation is UNSUBSTANTIATED. There is not a preponderance of the evidence to prove the allegation occurred.

An exit interview was conducted via telephone and a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to the Administrator via email. An electronic email read receipt confirms the documents were received.

SUPERVISOR'S NAME: Tony Girolami	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Jonathan C Pineda	TELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020

LIC9099 (FAS) - (06/04)

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