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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 01:14:52 PM

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
08/11/2023 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 18-AS-20230811133124
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:
09:49 AM
MET WITH:Loucinda HickersonTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff does not ensure resident dental care needs are being met
Staff do not assist resident with transportation to the dental office
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 5, 2025, the Department requested and received copies of the following: Staff roster (dated 10/4/25) Resident Roster (dated 10/22/25), R1 physician’s report (dated 3/17/23), Needs and Services Plan (dated 8/21/23), R1’s pre-placement appraisal (dated: 7/11/22), Dentist Authorization (dated 7/11/22), Dental hygienist report (dated 4/17/23). The Department conducted interviews with Executive Director (A1), and 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-20230811133124
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: Staff does not ensure resident dental care needs are being met

The detail of the complaint alleges that the facility is not ensuring that R1 receives needed dental care.

The Department interviewed Marie Hill Executive Director (A1) who denied the allegation, stating that R1 had received dental services while he lived in the facility. A1 stated that the responsible party signed the dental authorization form to agree to receive in house dental services where the Dental Hygienist or Dentist will provide services at the facility. A1 further stated that if the dental hygienist make a referral for services outside of the facility, then they typically discuss it with the resident's family so that arraignments could be made. Lastly, A1 stated on 4/17/23, R1 saw the Dental Hygienist who made a referral, however R1 declined the service because of the expense.

On 11/5/25, the Department obtained and reviewed the Dental Hygienist report (dated 4/17/23) which corroborated the Executive Director (A1) assertion that R1 did receive dental services while at the facility. Additionally, the Dental Hygiene report showed that a referral for dental services was made, but R1 stated that it was too expensive; therefore, declining the referral. Lastly, the Department reviewed dental authorization (dated 7/11/22) signed by the responsible party accepting services for R1 to be seen by dental hygienist and dentist that comes out to the facility.

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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-20230811133124
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 11/5/25, between 10:00am and 12:00pm, the Department interviewed 6 residents regarding dental services offered at the facility. 6 out of 6 stated that they are offered dental services; 4 out of 6 stated that a family member make appointments for them when needed and 2 out of 6 stated that they have dentures and doesn’t use any dental services.

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.

Allegation: Staff do not assist resident with transportation to the dental office.

The detail of the complaint alleges that “the facility does not transport R1 to the dental office, but rather a private dentist would come to the facility for all the residents.”

The department interviewed Executive Director Marie Hill (A1) regarding this allegation. A1 stated, “Usually the family would transport residents to the dentist because the family needs to make decisions for the resident’s care. The facility is not authorized to make medical discussions so the family will have to be there at the dental office to make decisions for care.”

On 11/5/25, the Department interviewed 6 residents regarding the allegation and of those interviewed 6 out of 6 stated that if they needed to see the dentist they would use the dentist on site, but if they needed outside services then family would transport them to the dentist.

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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-20230811133124
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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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