374604198-11-17-2023-18-AS-JDHS-D6EVC2-20240620161825

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604198
Report Date: 11/17/2023
Date Signed: 11/17/2023 09:22:35 AM

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
07/28/2023 and conducted by Evaluator Venus Mixson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230728130208

FACILITY NAME:	VISTA GARDENS		FACILITY NUMBER:	374604198
ADMINISTRATOR:	SANCHEZ, PAZ HILDA		FACILITY TYPE:	740
ADDRESS:	1863 DEVON PLACE		TELEPHONE:	(760) 295-3900
CITY:	VISTA	STATE: CA	ZIP CODE:	92084
CAPACITY:	99	CENSUS: 86	DATE:	11/17/2023
		UNANNOUNCED	TIME BEGAN:	08:48 AM
MET WITH:	RESIDENT SERVICES DIRECTOR, RACHEL MCINTYRE		TIME COMPLETED:	09:11 AM

ALLEGATION(S):

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Staff neglect resulted in resident sustaining broken cheekbone.

INVESTIGATION FINDINGS:

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On 11/17/2023, Licensing Program Analyst (LPA), Venus Mixson conducted a visit to the facility and met with the Residnet Services Director Rachel Mcintyre. The visit was conducted to provide the findings for the investigation pertaining to the listed allegation. During the investigation, the Department conducted interviews with Licensee, Administrator, facility staff/ residents, and additional witnesses.

On July 28, 2023, Community Care Licensing (CCL), received a complaint alleging staff neglect resulted in resident sustaining broken cheekbone. It was reported that an unknown resident physically attacked Resident #2, (R2). Information received from interviews and record review revealed Resident #1 (R1) was engaged in the physical attack against R2. The physical attacked occurred in the back of the facility near the Executive Directors Office. There were approximately ten to twelve staff and approximately 80 to 85 residents present at the facility at the time of the incident. This incident occurred early in the am, right after the morning meal and the previous safety check was prior to breakfast. A caregiver who found R2, assessed the situation, contacted the appropriate authorities, and provided first aid as needed. Additional information obtained stated that staff acted timely and appropriately when they found R2 injured, approximately less than 30 minutes after the incident. Facility staff reported the incident to the local authorities and required agencies in a timely manner. It was reported that there were no concerns of neglect/lack of supervision.

Based on staff and resident interviews, record reviews, and observations, the allegations have been deemed as “Unsubstantiated." An allegation finding of "unsubstantiated" means "although the allegations may have happened or are valid, there is not a preponderance of the evidence strand to prove the alleged violation did or did not occur.

An exit interview was conducted and a copy of this report, along with the LIC 811, was provided to the Residnet Services Director, Rachel Mcintyre.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

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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