374604274-8-26-2024-18-AS-TDAN-D8KQ89-20240828115621

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604274
Report Date: 08/26/2024
Date Signed: 08/26/2024 01:48:01 PM

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
06/19/2024 and conducted by Evaluator Sara Martinez

COMPLAINT CONTROL NUMBER: 18-AS-20240619165645

FACILITY NAME:	VISTA DEL LAGO MEMORY CARE		FACILITY NUMBER:	374604274
ADMINISTRATOR:	MARIE HILL		FACILITY TYPE:	740
ADDRESS:	1817 AVENIDA DEL DIABLO		TELEPHONE:	(760) 741-2888
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92029
CAPACITY:	96	CENSUS: 93	DATE:	08/26/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Marie Hill - Executive Director		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Staff are not ensuring that insulin is being administered in a safe manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sara Martinez arrived unannounced to the facility to conclude the investigation into the allegations listed above. LPA met with Executive Director Marie Hill and explained the purpose of the visit. Complaint investigation consisted of a tour of the interior/exterior areas of the facility, interviews with staff and residents, and records review of requested pertinent documents.

Regarding the allegation “Staff are not ensuring that insulin is being administered in a safe manner” it was reported Resident One (R1) receives insulin twice a day and staff are not checking R1’s blood sugar. Interview with Staff One (S1) reported R1 has a physician’s order stating R1’s blood glucose checks will be conducted one time a day on every Monday with a start date of 06/03/2024. LPA conducted a records review of R1’s order summary report that corroborates R1’s physician’s orders for blood glucose checks on Monday only. Records review of Medication Administrator Record (MAR) revealed on 06/03/2024, 06/10/2024, 06/17/2024, and 06/24/2024 staff have been conducting blood glucose checks and recording as directed.

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: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

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-20240619165645

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: VISTA DEL LAGO MEMORY CARE	FACILITY NUMBER: 374604274
	VISIT DATE: 08/26/2024

NARRATIVE

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Interview with R1 revealed staff have been following physician’s orders and have been checking R1’s blood sugar every Monday. This agency has investigated the complaint alleging “Staff are not ensuring that insulin is being administered in a safe manner”. 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 Hill.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

LIC9099 (FAS) - (06/04)

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