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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604294
Report Date: 12/12/2024
Date Signed: 12/12/2024 02:39:50 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/28/2021 and conducted by Evaluator Amy Rodgers
COMPLAINT CONTROL NUMBER: 08-AS-20210628125732
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: 172DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Executive Director, Jolene Farish TIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Licensee did not provide healthful accomodations for resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Amy Rodgers conducted an unannounced visit to conclude the complaint investigation regarding the above mentioned allegations. LPA was greeted at the front lobby by Executive Director, Jolene Farish and was granted entry after identifying herself and disclosing the purpose of the visit, which was to further invistagate a complaint.

During the invistagation the facility was toured, records reviewed, and interviews conducted with staff and outside sources.

(continued on 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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 08-AS-20210628125732
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: LAS VILLAS DEL NORTE
FACILITY NUMBER: 374604294
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2025
Section Cited
CCR
87468.1(a)(2)
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(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
This requirement is met as in evidence in:
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Licensee agrees to provide all staff with resident personal rights training by plan of correction date. Training and documents will be due to CCL by POC date.
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Based on records and interviews the licensee did not provide healfull and comfortable accomodations in 1 of 51 persons in the memory care unit which posed a potential Personal Rights risk to persons 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.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/28/2021 and conducted by Evaluator Amy Rodgers
COMPLAINT CONTROL NUMBER: 08-AS-20210628125732

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: 172DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Executive Director, Jolene Farish TIME COMPLETED:
02:50 PM
ALLEGATION(S):
1
2
3
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9
Staff not properly trained in cleaning/sanitation practices.
Resident was not accorded dignity.
INVESTIGATION FINDINGS:
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5
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Licensing Program Analyst (LPA), Amy Rodgers conducted an unannounced visit to conclude the complaint investigation regarding the above mentioned allegations. LPA was greeted at the front lobby by Executive Director, Jolene Farish and was granted entry after identifying herself and disclosing the purpose of the visit, which was to further invistagate a complaint.

During the invistagation the facility was toured, records reviewed, and interviews conducted with staff and outside sources.

In July of 2021, it was reported to Community Care Licensing Division (CCLD) that staff did not properly practice cleaning and sanitation protocols while changing the bedding of Resident #1(R1)(See LIC 811 for confidential name). The Department was able to locate individuals who had been present at the facility during the time period identified in the complaint allegation. Interviews with outside sources and staff were not able to provide any information to support or deny the complaint allegation. (continued on 9099-c)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20210628125732
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: LAS VILLAS DEL NORTE
FACILITY NUMBER: 374604294
VISIT DATE: 12/12/2024
NARRATIVE
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(continued form 9099)

In July of 2021, it was reported to Community Care Licensing Division (CCLD) that the Licensee representative spoke improperly about death to the reporting party, not to R1. Interviews with staff and outside sources were not able to provide any information to support or deny the complaint allegation.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Executive Director XXXX, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20210628125732
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: LAS VILLAS DEL NORTE
FACILITY NUMBER: 374604294
VISIT DATE: 12/12/2024
NARRATIVE
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(continued from 9099)

According to regulation CCR 87468 (titled "Personal Rights"), Licensee was required to provide “safe and healthful living accommodations.” In July of 2021, it was reported to Community Care Licensing Division (CCLD) Resident #1(R1)(See LIC 811 for confidential name) had ants crawling on their person and their bedding while residing in the memory care unit (Generations) of the facility. The Department was able to locate individuals who had been present at the facility during the time period identified in the complaint allegation. Interviews with outside sources and staff revealed ants were present inside the memory care unit of the facility during the time identified in the complaint allegations. Interviews with staff and an outside source revealed they observed R1 to have ants crawling on their person and in their bedding.


The Department has investigated the allegation that Licensee did not provide healthful accommodations for resident and has found that, based upon evidence found during interviews and record review, the preponderance of the evidence standard has been met. Therefore, this allegation is deemed substantiated.

This deficiency is noted on the attached 9099-D and is cited in accordance with the California Code of Regulations, Title 22. A copy of this report, along with Licensee/Appeal Rights,

An exit interview was conducted with Executive Director XXXX, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5