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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604294
Report Date: 11/16/2022
Date Signed: 11/16/2022 11:57:12 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/17/2022 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220517142036
FACILITY NAME:LAS VILLAS DEL NORTEFACILITY NUMBER:
374604294
ADMINISTRATOR:FARISH, JOLENEFACILITY TYPE:
740
ADDRESS:1325 LAS VILLAS WAYTELEPHONE:
(760) 741-1047
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:198CENSUS: 178DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Jolene Farish, Executive DirectorTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Physical Abuse of a Resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conclude an investigation into the allegation listed above. LPA met with Executive Director Jolene Farish and explained the purpose of the visit.
Regarding the allegation "Physical Abuse of a Resident", it was alleged that Resident #1(R1) was physically abused by Staff #1(S1) while in care. During the investigation, eleven(11) residents were interviewed however, only four(4) residents were able to be qualified. Two(2) of four(4) residents interviewed reported being hit by a staff member, one(1) of four(4) residents interviewed reported being hit by S1, and one(1) of four(4) residents interviewed reported observing a staff member hit another resident. Six(6) staff were also interviewed. One(1) of six(6) staff members interviewed reported they had been told to keep wandering residents away from S1's work area. Two(2) of six(6) staff interviewed reported being told of S1's abuse of residents. Finally, one(1) of six(6) staff interviewed reported observing S1 handle residents in a rough manner, push residents, and exhibit rude limited patience with residents. (CONTINUED ON LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
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 3
Control Number 18-AS-20220517142036
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: LAS VILLAS DEL NORTE
FACILITY NUMBER: 374604294
VISIT DATE: 11/16/2022
NARRATIVE
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(CONTINUED ON FROM LIC9099)
Based on LPA’s observations and interviews which were conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099 D. An exit interview was conducted and a copy of this report was provided along with LIC811 Confidential Names List.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20220517142036
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: LAS VILLAS DEL NORTE
FACILITY NUMBER: 374604294
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2022
Section Cited
CCR
87468.1(a)(3)
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Personal Rights of Residents in all Facilities-(a) Residents in all...care facilities for the elderly shall have... the following personal rights:(3) To be free from punishment, humiliation, intimidation, abuse, or other actions... such as...interfering with daily living functions such as eating, sleeping, or
elimination. This requirement was not met as
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Licensee/Executive Director stated all staff will attend training regarding the personal rights of residents to ensure compliance regarding this requirement. Proof of completion of training to be submitted to CCL by POC due date of 12/9/2022.
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evidenced by: Based on observation and interviews conducted with staff and residents, the Licensee did not ensure R1 was free from physical abuse while in care which poses an immediate health, safety, and personal rights risk to residents in care.
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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: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3