374604294-6-29-2022-08-AS-IESA-CGTUQY-20220730154756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604294
Report Date: 06/29/2022
Date Signed: 06/29/2022 02:06:49 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/06/2021 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20211206131259

FACILITY NAME:	LAS VILLAS DEL NORTE		FACILITY NUMBER:	374604294
ADMINISTRATOR:	FARISH, JOLENE		FACILITY TYPE:	740
ADDRESS:	1325 LAS VILLAS WAY		TELEPHONE:	(760) 741-1047
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92026
CAPACITY:	198	CENSUS: 166	DATE:	06/29/2022
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Executive Director, jolene Farish		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Neglect/Lack of Supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. The LPA was greeted by Executive Director, Jolene Faris, identified himself, and disclosed the purpose of the visit.

The Department’s investigation consisted of a health and safety check, review of records, and interviews with internal and external sources.

It was alleged Lack of supervision resulted in Resident # 1 (R1), Resident # 2 (R2), and Resident # 3 (R3) being sexually abused by a stranger. A review of Police reports obtained by the Department, confirmed the identity of the suspected abuser (SA) - See Confidential Names list LIC 811 to identify SA. An interviewed with R1 revealed that on 12/03/2021, at approximately 4:00 am, SA entered R1’s room and stood by the door.
(See LIC 809C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 380-3797
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 755-7595
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

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 08-AS-20211206131259

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: LAS VILLAS DEL NORTE	FACILITY NUMBER: 374604294
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/29/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/22/2022 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	87468.2 Additional Personal Rights of Residents in Privately Operated Facilities:(a) In addition to the rights listed in Section 87468.1,Personal Rights of Residents in All Facilities,residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator has implemented a quality assurance protocol where personnel verify lobby doors are locked. Moving forward, the administrator will develop a log to track who is verifying the lobby doors are locked.
	8 9 10 11 12 13 14	Based on observation, interviews, record review, the licensee did not ensure residents were free from sexual abuse in 3 of 166 persons in care [R1, R2, and R3] which posed an immediate Health, Safety, or Personal Rights risk to persons in care.	8 9 10 11 12 13 14	Administrator has trained all facility personnell on the new protocol, and will submit a log to the LPA documenting the attendees. Administrator will submit all documention by 6/30/22.
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	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 380-3797
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 755-7595
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 08-AS-20211206131259

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: LAS VILLAS DEL NORTE	FACILITY NUMBER: 374604294
	VISIT DATE: 06/29/2022

NARRATIVE

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When asked what SA was doing at the facility by R1, SA proceeded to grab his genitals and state SA was there to please the women. R1 proceeded to ask SA to leave, only to have SA come back within 15 minutes and again R1 telling SA to leave again. An interview with an outside source, a review of a police report, and an interview with Police Officer (P1), who responded to the facility, and obtained R1’s initial statement, corroborated the information provided by R1 to be consistent.

An Interview with R2 revealed that on 12/3/2021, R2 woke up to find SA lying next to R2, masturbating and groping R2’s breast. R2 proceeded to tell SA to leave. SA initial refused, but soon after complied and left. R2 then walked to the facility’s Wellness Center on the second floor of the facility and notified Staff # 1 (S1). An interview with an outside source, a review of a police report, and an interview with P1, corroborated the information provided by R2 to be consistent. An interview with R3 revealed SA entered R3’s room at approximately 4:30 am, on 12/3/2021. SA stood by the doorway with SA’s hands on SA’s private parts, until R3 screamed at SA to leave. An interview with an outside source, a review of a police report corroborated the information provided by R3 to consistent.

Interviews of S1 and Staff # 2 (S2) revealed SA was seen inside the facility withing the hours of 4am to 5am. S2 saw SA walking through the memory care unit doors, noticed SA was not an employee and proceeded to ask S1 for assistance in locating SA. While conducting a search and checking doors, Staff # 3 and Staff # 4, staff assigned to the memory care unit, notified S1 and S2 one of the resident (S4) in the memory care unit had reported an unknown individual knocked on a patio door and attempted to grab the resident. S1 and S2 continued to search the facility and witnessed SA exiting R3’s room. Both S1 and S2 escorted SA out of the facility and notified law enforcement.

A police report obtained during the investigation revealed SA encountered several locked doors around the facility but was able to gain entry through the unlocked lobby doors. Interviewed staff declined ever witnessing the lobby doors being propped open or being unlocked during the timeframe in question. Interviews with outside sources revealed the front doors to the lobby have been found unlocked and propped open early in the morning, on multiple occasions. Facility observations during the investigation revealed multiple patio doors, meant to be locked, were unlocked. An interview with staff revealed this was not the first time an unknown individual has entered the facility campus.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 380-3797
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 755-7595
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 08-AS-20211206131259

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: LAS VILLAS DEL NORTE	FACILITY NUMBER: 374604294
	VISIT DATE: 06/29/2022

NARRATIVE

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Based on the evidence gathered from police reports, records reviewed, and interviews with internal and external sources, the preponderance of evidence standard was met to Substantiate the above allegation. This deficiency was cited in the attached LIC 9099D. A Plan of Correction was jointly discussed and formulated with Executive Director, Jolene Farish. At this time, per Health and Safety Code Section 1569.49, a civil penalty assessment is under review by the Program Administrator of the Community Care Licensing Division.
An exit interview was conducted with Executive Director, Jolene Farish, to whom a copy of this report and the Licensee Rights (LIC9058 9/16) were provided to.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 380-3797
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 755-7595
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

LIC9099 (FAS) - (06/04)

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