374604294-1-26-2023-18-AS-DMUN-CNLPV2-20230131103823

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604294
Report Date: 01/24/2023
Date Signed: 01/26/2023 03:13:39 PM

Unsubstantiated

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
06/02/2022 and conducted by Evaluator Tricia Danielson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220602121633

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:	01/24/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Ana Cruz, Memory Care Director		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff do not properly supervise residents
Staff did not assist resident with medical device
Staff did not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conclude an investigation into the allegations listed above. LPA met with Memory Care Director Ana Cruz and explained the purpose of today's visit. This visit was incorrectly identified as having been conducted 1/24/2023. The visit was actually conducted 1/25/2023. *This is an amended report. Regarding the allegation "Staff do not properly supervise residents", it was alleged that memory care residents were left unsupervised and then wandered into Resident #1's (R1) room and interupted R1's visit with family. Interviews conducted with staff indicated approximately ten(10) to twelve(12) residents are assigned to each caregiver during AM shift, ten(10) to fifteen(15) residents are assigned to each caregiver during PM shift, and fifteen(15) residents are assigned to each caregiver during NOC shift. There are four(4) additional staff assigned to memory care each AM shift to assist and supervise residents, three(3) additional staff assigned to memory care for at least part of the PM shift to assist and supervise residents, and one(1) additional staff assigned to memory care each NOC shift to assist staff and residents. Interviews conducted also revealed residents are free to walk about the unit at their leisure for either exercise, personal time, or to visit with other residents in the various areas of the unit. Regarding the allegation "Staff did not assist resident with medical device", it was alleged that R1 did not receive assistance with their CPAP machine at bedtime. (CONTINUED ON LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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-20220602121633

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: 01/24/2023

NARRATIVE

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(CONTINUED FROM LIC9099)
Interviews conducted and records reviewed revealed R1 did receive nightly assistance in donning their CPAP mask and turning it on for use however, this would not prevent R1 from removing the mask and either allowing it run dry or turn it off entirely after time. Regarding the allegation "Staff did not safeguard resident's personal belongings", it was alleged that staff did not take measures to prevent the loss of some of R1's property. Interviews conducted also revealed R1 was issued a key to their room to prevent entry to others and to safeguard their property but eventually lost it. Following the loss of the key, R1 required near constant reminder to shut their room door. Staff did not lock R1's room as this would have prevented R1 from having direct and immediate access to their room at their leisure. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names List.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC9099 (FAS) - (06/04)

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