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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604274
Report Date: 11/05/2025
Date Signed: 11/05/2025 11:56:43 AM

Unsubstantiated


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
08/09/2023 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 18-AS-20230809121001
FACILITY NAME:VISTA DEL LAGO MEMORY CAREFACILITY NUMBER:
374604274
ADMINISTRATOR:GONZALEZ, JEFFFACILITY TYPE:
740
ADDRESS:1817 AVENIDA DEL DIABLOTELEPHONE:
(760) 741-2888
CITY:ESCONDIDOSTATE: CAZIP CODE:
92029
CAPACITY:96CENSUS: 96DATE:
11/05/2025
UNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Loucinda HickersonTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Resident was admitted without consent of responsible person.
Staff do not distribute medications according to physician’s orders.
INVESTIGATION FINDINGS:
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On November 5, 2025, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegations and to deliver findings. The Department was met by Loucinda Hickerson, Memory Care Director and the purpose of the visit was explained.

Investigation consisted of the following:
On 8/14/23 the Department conducted an unannounced initial visit to the facility to investigate the complaint allegations mentioned above. During the visit, it was determined that the complaint required further investigation.
On November 4, 2025, the Department requested and received copies of the following: Staff roster (dated 10/4/25) Resident Roster (dated 10/22/25), R1's physician’s report (dated 3/17/23), R1's Needs and Services Plan (dated 8/21/23), R1’s pre-placement appraisal (dated: 7/11/22) admission agreement (dated:7/12/22). R1 Medication Administration Record (MAR) dated:August-September 2023, Physican's orders (dated September 2023), Staff Medication training (dated 11/29/23) and Progress notes (dated July, Aug, Sept 2023).The Department conducted interviews with 5 staff (S1-S5) and Administrator (A1). On November 5, 2025, the Department interviewed 6 residents (R2-R7).
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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
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 4
Control Number 18-AS-20230809121001
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: 11/05/2025
NARRATIVE
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The investigation revealed the following:

Allegation: Resident was admitted without consent of responsible person

The detail of the complaint alleges that the resident nor his conservator sign the admission agreement.

On November 4, 2025, at 12:43pm the Department interviewed Executive Director Marie Hill (A1) who denied the allegation stating the responsible party did sign the admission agreement. A1 further stated that the Residents do not sign because the facility is full memory care and they need their responsible party to sign.

On November 4, 2025, between 1:00pm and 2:30pm, the Department interviewed 5 staff (S1-S5) regarding the allegation. Of those interviewed 5 out of 5 could not provide any input on this allegation because they are not part of the residents' admission agreement signing process.

On November 4, 2025, the Department obtained and reviewed a copy of the R1’s admission agreement which revealed that the document was signed by the responsible party and the Executive Director.

Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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, therefore the allegation is UNSUBSTANTIATED.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20230809121001
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: 11/05/2025
NARRATIVE
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Allegation: Staff do not distribute medications according to physician’s orders.

The detail of the complaint alleges that the staff doesn’t give R1 his medication on time.

On November 4, 2025, at 12:43pm, the Department interviewed Marie Hill (A1) who denied the allegation stating that there has been no report of R1 missing medication. A1 further stated that her staff are trained on medication administration and have frequent refreshers. A1 states that “the facility get the orders from the doctor, it's sent to the pharmacy first and they check orders before it is sent to us. Then we check and double check the order to make sure it is correct.”

On November 4, 2025, between 1:00pm and 2:30pm, the Department interviewed 5 staff (S1-S5) regarding the allegation. Of those interviewed 5 out of 5 denied allegation stating that R1’s medication was given on time and as directed by the doctor. 5 out of 5 staff state that they have had medication training. Lastly, 5 out of 5 state that missed medication is rare, but when it happens they report it to the doctor, the responsible party and to the Department via incident report.

On November 5, 2025, between 10:00am and 12:00pm the Department interviewed 6 residents (R2-R7). R1 was not interviewed as R1 no longer lives at the facility as of 10/25/24. Of those interviewed 6 out of 6 stated that they receive their medication on time and they have never missed a dose due to staff not giving it.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20230809121001
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: 11/05/2025
NARRATIVE
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On November 4, 2025, the Department obtained, reviewed and evaluated R1’s Medication Administration Record (MAR) for the months of August-September 2023 and found no discrepancies during the review period.

Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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, therefore the allegation is UNSUBSTANTIATED.

There were no deficiencies cited during today's visit.

Exit interview conducted and copy of report provided.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4