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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604294
Report Date: 01/06/2023
Date Signed: 01/06/2023 11:10:33 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
07/20/2022 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220720173917
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: 174DATE:
01/06/2023
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Jolene Farish, Executive DirectorTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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9
Staff did not respond to resident's call for assistance in a timely manner
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 "Staff did not respond to resident's call for assistance in a timely manner", it was alleged that when Resident #1(R1) activated their call pendant, it took staff forty(40) minutes to one(1) hour to respond. It was further alleged that R1 had fallen from their scooter on one occasion and waited for hours on the floor for assistance. Interviews were conducted with ten(10) residents. Nine(9) of ten(10) residents reported facility staff do respond to call lights in a timely manner. One(1) of ten(10) residents interviewed has not utilized the call light system. However, records reviewed indicated R1 activated their call light thirty-seven(37) times in the period in question. Only forteen(14) of R1's thirty-seven(37) call lights were responded to within fifteen(15) minutes. Eight(8) of R1's thirty-seven(37) call lights were responded to in sixteen(16) to twenty(20) minutes, five(5) of R1's thirty-seven(37) call lights were responded to in twenty-one(21) to thirty(30) minutes, six(6) of R1's thirty-seven(37) call lights were responded to in thirty-one(31) (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: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
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 5
Control Number 18-AS-20220720173917
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: 01/06/2023
NARRATIVE
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(CONTINUED FROM LIC9099)
to forty-five(45) minutes, one(1) of R1's thirty-seven(37) call lights was responded to fifty-one(51) minutes, and three(3) of R1's thirty-seven(37) call lights were responded to beyond one hour(1) and nineteen(19) minutes. Records reviewed revealed the longest response time for any of R1's call lights was one(1) hour and thirty-three (33)minutes. Based on LPA’s observations and interviews which were conducted and record reviews, 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 and Appeal Rights.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20220720173917
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: 01/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/20/2023
Section Cited
CCR
87468(a)
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Personal Rights- (a) Residents in residential care facilities for the elderly shall have personal rights...those listed in Sections 87468.1, Personal Rights... and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. This requirement was not met as evidenced by: The Licensee did not ensure
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The facility stated a training will be conducted with all caregivers to outline their responsibilites in responding to resident's call lights in a timely manner. Proof of training will be provided to LPA by January 20, 2023.
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resident's call light alarms were answered in a timely manner. Based on records reviewed, R1'sl light alarms were not answered in a timely manner. This poses a potential 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: 01/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
07/20/2022 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220720173917

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: 174DATE:
01/06/2023
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Executive Director Jolene FarishTIME COMPLETED:
09:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide resident with an ADA compatible room
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
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12
13
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 today's visit. Regarding the allegation "Staff did not provide resident with an ADA compatible room", it was alleged that Resident #1(R1) was informed by facility staff that their room would be compatible with Americans with Disabilities Act(ADA) requirements and the room was not ADA compatible. The investigation revealed that prior to admission, R1 was provided a virtual tour of the facility including the specific room which R1 would utilize during their stay at the facility. Interviews conducted revealed R1 did not express any hesitation concerning the room's amenities during the virtual tour and notes made by facility staff following the tour indicated R1 expressed a favorable opinion of the room. Furthermore, records reviewed indicated R1 signed an admission agreement which indicated they chose the room number listed in the agreement. R1's signature on the agreement was verified to be that of R1. This agency has investigated the complaint alleging "Staff did not provide resident with an ADA compatible room". We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names List. *This is an amended report.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
07/20/2022 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220720173917

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: 174DATE:
01/06/2023
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Executive Director Jolene FarishTIME COMPLETED:
09:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not meet resident's hygiene needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 "Staff did not meet resident's hygiene needs", it was alleged that Resident #1(R1) went twelve(12) days without a shower during their stay at the facility. Records reviewed indicated R1 was scheduled for six(6) staff assisted showers during their stay at the facility. The facility does not keep record of resident showers completed or refused. R1 was unable to be interviewed. Interviews conducted with ten(10) residents indicated seven(7) of ten(10) residents received assistance with showers as scheduled. Three(3) of those ten(10) residents interviewed do not require assistance with showers. Based on the information available, the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
An exit interview was conducted and a copy of this report was provided along with LIC811-Confidential Names List. *This is an amended report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 5