374604274-4-13-2022-18-AS-CCON-CDFQAH-20220413115959

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604274
Report Date: 04/13/2022
Date Signed: 04/13/2022 12:00:10 PM

Document Has Been Signed on 04/13/2022 12:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

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: 89	DATE:	04/13/2022
TYPE OF VISIT:	Case Management - COVID-19	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jeff Gonzales - Administrator		TIME COMPLETED:	12:15 PM

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	Licensing Program Analyst (LPA) Crystal Colvin, and Sandy Brackman and Elizar Perez of the San Diego County Health and Human Services Agency, Healthcare-Associated Infections (HAI) Program, arrived at the facility for the purpose of follow-up on the recent outbreak of COVID-19 cases at the facility. LPA Colvin and HAI staff met with Administrator Jeff Gonzales and informed him of the purpose of today's visit. An on-site visit was conducted to provide technical assistance and to evaluate the facility's disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment. During today's visit, LPA Colvin and HAI staff interviewed Administrator Jeff Gonzales and conducted a walk-though of the facility. LPA Colvin observed that there were COVID-19 and infection control signs posted throughout the facility, and that staff were utilizing PPE, such as N95 & KN95 face masks. LPA Colvin observed PPE stations still situated outside of some resident rooms, along with uncovered trash cans. LPA Colvin inquired about if the facility had trash cans with lids to use instead, and Administrator Gonzales stated that they had some they purchased for a prior COVID-19 outbreak, but that he was not sure where they were and would look into it. LPA Colvin and HAI staff additionally reviewed the facility's staffing plan and need with Administrator Gonzales, who stated that staffing levels were improving and that they have three companies that they contract with for additional staff. LPA Colvin inquired about fit testing for N95 masks for staff, which is particularly relevant during a COVID-19 outbreak, and Administrator Jeff Gonzales stated that staff were initially fit tested in 2020/2021, but that they have obtained new staff since then and the new staff have not been fit tested. LPA Colvin advised for staff to be fit tested as soon as possible, as well as informed Administrator Gonzales that fit testing is to be done annually, so the staff that were previously fit tested are likely due for fit testing again. Administrator Gonzlaes stated that he would contact corporate office to see about getting fit testing done for all staff.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: VISTA DEL LAGO MEMORY CARE	FACILITY NUMBER: 374604274
	VISIT DATE: 04/13/2022

NARRATIVE

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During today's inspection, LPA Colvin observed ceiling cameras in some residents rooms in one wing of the facility. Administrator Gonzlaes stated that this is a pilot program that they are testing out called "Safely You", and that it does not record 24/7, but only 10 minutes before and after it detects a fall. After a fall is detected, the system sends an alert to facility staff, and if there is no response in two minutes, the Administrator is automatically contacted via telephone. Administrator Gonzales stated that the cameras are only in the rooms of those residents whose family consented. LPA Colvin inquired as to if the facility or licensee had sent any information on this new program to the San Diego Community Care Licensing (CCL) Office, as the facility was previously overseen by that office. Administrator Gonzales stated that he was not sure if it had, but did not think so.

LPA Colvin is recommending an Informal Meeting to be held with the Licensee, Administrator, and the LPA assigned to this facility along with a Licensing Program Manager (LPM). LPA Colvin informed Administrator Jeff Gonzlaes of the reason for the proposed meeting (cameras), and that CCL needs to review these changes to the facility's Program Plan as well as confirm if the program is allowed by Title 22 Regulations, or if a Waiver would be required. Administrator Gonzales will provided LPA Colvin with information on the Safely You Program via email along with signed consent forms for the rooms with the devices installed.

An exit interview was conducted with Administrator Jeff Gonzales and a copy of this report was provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

LIC809 (FAS) - (06/04)

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