374604274-9-4-2024-18-AS-TDAN-D9A2RQ-20240919173752

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604274
Report Date: 09/04/2024
Date Signed: 09/04/2024 01:24:01 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
08/29/2024 and conducted by Evaluator Sara Martinez

COMPLAINT CONTROL NUMBER: 18-AS-20240829163133

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:	09/04/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Marie Hill - Executive Director		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff failed to ensure resident's insulin orders were followed

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sara Martinez arrived unannounced to the facility to initiate 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 failed to ensure resident's insulin orders were followed” it was reported Resident One (R1) is not receiving insulin five times a day as prescribed by R1’s physician. Records review of R1’s Physician’s Orders reveal R1 is prescribed two separate insulin dosages in the morning, one insulin dosage in the afternoon, and two separate insulin dosages in the evening. Record review of R1’s Medication Administrator Record (MAR) for June 2024, July 2024, and August 2024 provides corroborating documentation of R1 receiving five shots of insulin prescribed by R1’s physician. Interview with Staff One (S1) reported R1 receives in total five shots of insulin each day, two in the morning, one in the afternoon, and two in the evening.

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: 09/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 18-AS-20240829163133

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: 09/04/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Interview with R1 reported they receive their insulin in the morning at 8am, in the afternoon at 12am, and in the evening at 4pm. Interview with Staff Two (S2) revealed R1 receives two types of insulin shots in the morning, one in the afternoon, and two types of insulin at dinner. S2 reported staff check R1’s glucose three times a day before administering insulin so R1 can receive the correct dosage of units/ml of insulin.

This agency has investigated the complaint alleging “Staff failed to ensure resident's insulin orders were followed”. 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: 09/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2