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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604198
Report Date: 08/09/2024
Date Signed: 08/09/2024 09:38:10 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
11/30/2023 and conducted by Evaluator Venus Mixson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20231130154250
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:0CENSUS: 0DATE:
08/09/2024
UNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:RESIDENT SERVICES DIRECTOR (RSD), AMY SALVADORTIME COMPLETED:
09:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to provide resident with care in personal hygiene.
Staff failed to provide necessary medical care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On August 09, 2024, Licensing Program Analyst (LPA), Venus Mixson conducted a visit and met with Amy Salvador, RSD. The visit was conducted to provide the findings for the listed allegations. The investigation consisted of staff and resident interviews, witness interviews, record reviews, and LPA's observations.
On November 30, 2023, Community Care Licensing received a complaint alleging that the facility did not provide Resident Number 1 (R1), with proper personal hygiene and medical care. It was also reported that R1 had malnutrition or dehydration due to mental health limitation and lack of care and supervision by the facility. Additionally, it was reported that R1 demonstrates continuing decline in care for self and no suitable caregiver. Finally, it was reported that R1 has advanced dementia and that it is unclear if the information is credible.
Regarding the allegation staff failed to provide resident with care in personal hygiene, information obtained from staff interviews advised that R1 was on PACE and relocated from the facility on 03/11/2024. Additional information obtained from staff interview stated R1 had a care and services plan and that the care and services plan was followed. It was also advised that Facility Staff provided necessary medical care, assisted with reminders. Lastly, it was advised that R1 was in the advanced stages of dementia and was declining that there were goals in place for assistance with daily routine and assistance with dressing and grooming as needed. Information obtained through the record review revealed that Facility Staff aided, as needed, with activities of daily living, such as bathing, dressing, ambulating, and assistance with medications. Additional information obtained via records reviewed demonstrated Facility Staff assist R1, as needed, with scheduling of medical and dental appointments and with accessing community resources and transferring to outside facilities, as needed, and prescribed by R1’s primary care physician. Information obtained does not corroborate the allegation.
Regarding the allegation staff failed to provide necessary medical care, information obtained from staff interviews and record reviews revealed that R1’s medical care plan was followed as prescribed by R1’s primary care physician. Information obtained from interviews with facility staff, record reviews, and witness interviews does not support the allegation.
Based on interviews with facility staff and witness, record reviews, and observations by LPA the preponderance of evidence standard has not been met. Therefore, allegations of Staff failed to provide resident with care in personal hygiene and Staff failed to provide necessary medical care, has been deemed as "UNSUBSTANTIATED." An allegation finding of "unsubstantiated" means 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 was discussed and provided to Amy Salvador, Resident Services Director.




Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
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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