374604269-6-26-2024-18-AS-TDAN-D8EVA2-20240823161513

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604269
Report Date: 06/25/2024
Date Signed: 06/26/2024 08:30:47 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
06/21/2024 and conducted by Evaluator Sara Martinez

COMPLAINT CONTROL NUMBER: 18-AS-20240621115113

FACILITY NAME:	FELICITA VIDA		FACILITY NUMBER:	374604269
ADMINISTRATOR:	MALASPINA, KIMBERLY		FACILITY TYPE:	740
ADDRESS:	930 MONTICELLO DRIVE		TELEPHONE:	(760) 747-4888
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92029
CAPACITY:	123	CENSUS: 92	DATE:	06/25/2024
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Kimberly Malaspina - Executive Director		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Victim was left on floor until fire department arrived as a result of facility staff's negligence

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sara Martinez made an unannounced visit to the facility to commence a complaint investigation regarding the allegation listed above. LPA was granted entry and met with Executive Director Kimberly Malaspina who was informed of the purpose of the visit and the elements of the allegation. During today's visit, LPA toured the facility, conducted staff and resident interviews, and reviewed documentation pertinent to the investigation.

Regarding the allegation “Victim was left on floor until fire department arrived as a result of facility staff's negligence” it was reported Resident One (R1) had a fall at the facility and staff left R1 on the ground and refused to assist R1 up off of the floor due to facility’s policy. Interview with Reporting Party (RP) revealed R1 was on the ground and had stated they were experiencing back pain and hip pain. Interview with R1 revealed they had fallen in their room and told staff they were experiencing back pain but did not want to go to the hospital. R1 stated staff arrived quickly to R1’s room to help. Staff One (S1) reported R1 had activated their pendent around 3:40am due to an unwitnessed fall.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024

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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Control Number 18-AS-20240621115113

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: FELICITA VIDA	FACILITY NUMBER: 374604269
	VISIT DATE: 06/25/2024

NARRATIVE

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S1 found R1 in their room on the floor by their bed in a sitting position. S1 had conducted an assessment of R1 and asked if R1 had hit their head, if R1 was experiencing pain anywhere on their body, and observing R1 for visible injuries. S1 did not assist R1 up off the floor due to R1 expressing lower back pain and hip pain on their right side. S1 reported due to the facility’s policy, they contacted Emergency Medical Services (EMS) and did not move the resident off the floor to ensure resident’s safety. Interview with Health and Wellness Director Amber Suttie reported staff procedure regarding unwitnessed falls are for staff to assess the resident’s condition prior to assisting the resident off the floor. If residents report to staff a head injury, pain, or if resident has observable injuries, EMS is contacted for further medical assessment.

Records review revealed staff notes dated 06/20/2024 at 3:45am EMS was called due to R1’s unwitnessed fall and R1 reporting to staff lower back pain and pain to the right hip area. Interview with S1 and RP revealed R1’s pendent was activated at 3:40am and EMS arrived at approximately 3:52am. This agency has investigated the complaint alleging "Victim was left on floor until fire department arrived as a result of facility staff's negligence". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to Executive Director Malaspina.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024

LIC9099 (FAS) - (06/04)

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