374604198-4-15-2022-08-AS-IESA-D2XADL-20240229230808

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604198
Report Date: 04/14/2022
Date Signed: 04/15/2022 06:25:49 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/07/2021 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20210607164333

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: 80	DATE:	04/14/2022
		UNANNOUNCED	TIME BEGAN:	06:30 PM
MET WITH:	Karina Tellez, Business Office Manager and Rachel McIntyre, Intrim Executive Director		TIME COMPLETED:	06:55 PM

ALLEGATION(S):

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- Staff did not provide incontinence care for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Carmen Lopez, conducted an unannounced visit to the facility to deliver findings for a complaint investigation regarding the above-mentioned allegations. LPA Lopez identified herself and was granted entry by Edith Osio, Concierge. LPA stated the purpose of the visit with Rachel McIntyre, Interim Executive Director and Karina Tellez, Business Office Manager.

The Department’s investigation consisted of the review of records, interviews with staff and outside sources which were pertinent to this investigation.

On 06/07/21, It was alleged that staff did not provide resident R1 with incontinence care as indicated in the written care plan. Review of documentation showed that R1 had a bowel and bladder impairment which required daily assistance with incontinence care. Facility records revealed that the resident needed PeriGuard ointment applied topically to the bilateral buttock area every day for prophylaxis (intended to prevent disease).

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

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-20210607164333

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: VISTA GARDENS	FACILITY NUMBER: 374604198
	VISIT DATE: 04/14/2022

NARRATIVE

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A website search states that the ointment is a protectant that helps relieve and prevent rashes and irritation due to wetness from incontinence. Facility records indicated that the ointment was an active order since 1/29/21. However, evidence obtained in records and interviews did not confirm if staff used this ointment with R1. Interviews with credible outside sources confirmed that R1, at times, may have not received adequate incontinence care due to staff shortages. Outside sources recalled that at night R1 needed assistance with being changed, but staff did not respond to assist the resident. Interview with another credible outside source confirmed that multiple occasions, staff would arrive to their assigned shift and would observe unspecified residents soiled and in need of incontinence care. According to outside sources, residents would not have their soiled diapers changed until the next shift. Interviews with staff were inconsistent regarding resident incontinence care and denied the allegation; however, evidence obtained supported the allegation that staff did not provide incontinence care for the resident.

The Department has investigated the above-mentioned allegation and based upon the evidence obtained the preponderance of evidence standard was met, meaning there is sufficient evidence to prove the allegations occurred. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099D.

The report was discussed and plan of correction was jointly developed with Rachel McIntyre, Interim Executive Director and Karina Tellez, Business Office Manager, and a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to the Rachel McIntyre, Interim Executive Director via email. An electronic email receipt confirms the documents were received.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20210607164333

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 04/14/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/29/2022 Section Cited CCR 87625	1 2 3 4 5 6 7	87625 Managed Incontinence (b)(3) … the licensee shall be responsible for… ensuring that incontinent residents are kept clean and dry… This requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Interim ED will have an outside vendor (Home Health Agency) provide in-service training on managing incontinence. Proof of in-service training to be provided to CCL by POC date, Friday, April 29, 2022.
	8 9 10 11 12 13 14	Based on interviews the Facility did not ensure that R1’s incontinence briefs were changed as needed. This posed a potential Health risk to 1 out if 57 residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

LIC9099 (FAS) - (06/04)

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