374604274-11-6-2025-18-AS-RORN-DNZRJJ-20251203120400

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604274
Report Date: 11/06/2025
Date Signed: 11/06/2025 11:35:20 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
03/16/2023 and conducted by Evaluator Deborah Lee

COMPLAINT CONTROL NUMBER: 18-AS-20230316164248

FACILITY NAME:	VISTA DEL LAGO MEMORY CARE		FACILITY NUMBER:	374604274
ADMINISTRATOR:	GONZALEZ, JEFF		FACILITY TYPE:	740
ADDRESS:	1817 AVENIDA DEL DIABLO		TELEPHONE:	(760) 741-2888
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92029
CAPACITY:	96	CENSUS: 96	DATE:	11/06/2025
		UNANNOUNCED	TIME BEGAN:	08:47 AM
MET WITH:	Loucinda Hickerson		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not notify responsible party of a resident's fall resulting in medical attention.
Staff failed to administer resident's medications as prescribed

INVESTIGATION FINDINGS:

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On November 6, 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 Memory Care Director Loucinda Hickerson and the purpose of the visit was explained.

Investigation consisted of the following:
On 3/22/23 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's physician’s report (dated 9/8/22), R1's Needs and Services Plan (dated 2/19/23), R1 Physican's orders (dated August 2023), Staff Medication training (dated 11/29/23).
The Department conducted interviews Executive Director (A1) and 6 Residents (R2-R7).
On 11/6/25, the Department obtained and reviewed R1's Medication Administration Record (November 2022), Physician Orders (November 2022), and R1's Admission Agreement (dated 9/22/22).

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025

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-20230316164248

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: 11/06/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Staff did not notify responsible party of a resident's fall resulting in medical attention

The detail of the complaint alleges that responsible party was not notified that R1 had fallen on 2/24/23.

On 11/4/25, at 12:43 p.m., the Department interviewed the Executive Director (A1) who denied the allegation, stating that no fall was reported on 2/24/23. However, she confirmed that an unwitnessed fall did occur on 2/12/23, and that the responsible party was notified of the fall through an incident report.

On 11/4/25, the Department obtained and reviewed an incident report concerning an unwitnessed fall that took place on 2/12/23. The report confirmed that appropriate notifications were made, including to the responsible party and the primary care physician. It further indicated that no head impact occurred, and no injuries were sustained.

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: 11/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20230316164248

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: 11/06/2025

NARRATIVE

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Allegation: Staff failed to administer resident's medications as prescribed

The detail of the complaint alleges that R1’s medication was not refilled resulting in R1 missing medication.

On 11/4/25, at 12:43 p.m., the Department interviewed Executive Director Marie Hill (A1), who denied the allegation, stating that there had been no report of R1 missing any medication. A1 stated that staff members are trained in medication administration and receive regular refresher training. A1 further described the facility’s process: “The doctor sends the orders to the pharmacy, where they are reviewed before being forwarded to us. We then check and double-check the orders to ensure accuracy.”

On 11/5/25, between 10:00 a.m. and 12:00 p.m., the Department interviewed 6 residents (R2–R7). R1 has not resided at the facility since 10/25/24. 6 out of 6 residents reported that they consistently receive their medication on time and have never missed a dose due to staff error.

On 11/6/25, the Department obtained, reviewed and evaluated R1’s Medication Administration Record (MAR) and Physicians orders for the month of November 2022 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: 11/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025

LIC9099 (FAS) - (06/04)

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