374604294-2-8-2024-18-AS-JDHS-D2VS3R-20240228123134

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604294
Report Date: 12/01/2023
Date Signed: 02/08/2024 03:17:10 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
09/28/2023 and conducted by Evaluator Jacqueline Shaw Ross

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230928103442

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: 160	DATE:	12/01/2023
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Jolene Farish, Executive Director		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Facility does not have adequate food supply.

INVESTIGATION FINDINGS:

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Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross	TELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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-20230928103442

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: LAS VILLAS DEL NORTE	FACILITY NUMBER: 374604294
	VISIT DATE: 12/01/2023

NARRATIVE

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Cont'd from LIC9099....

R5 also stated they believe the lasagna served last week could have caused food poisoning among some of the residents, and that a number of residents have been sick with diarrhea since last week. Of the five (5) staff interviewed, all indicated there is a stomach virus that is going around, and some residents have been sick however, it is not related to food service. LPA conducted an interview with the facility chef who stated all meals are eaten by both staff and residents, and that none of the staff members have reported food poisoning. The facility chef also stated they have always maintained an ample supply of quality food and have never substituted water for milk in cereal. Facility chef further stated the only time they have had a milk shortage was approximately two months ago, there was a mix up with the delivery of milk. He further reported they immediately made a run to a local grocery store across the street to obtain milk, and it was replenished the same day. LPA toured the kitchen and observed an ample supply of both perishable and non-perishable food and drink.

LPA also reviewed pertinent documents from the facility that included a four (4) month supply of grocery receipts from June 2023 through September 2023. Review of receipts show a consistent supply of food and drinks were purchased prior to the allegation. Based on observation, interviews, and records review, the allegation that the facility does not have adequate food supply, is UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

This is an amended version of the original report crafted on 12/01/2023.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross	TELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
09/28/2023 and conducted by Evaluator Jacqueline Shaw Ross

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230928103442

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:	DATE:	12/01/2023
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Jolene Farish, Executive Director		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Staff did not ensure resident was provided fluids resulting in dehydration.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Jacqueline Shaw Ross made an unannounced visit to the facility to commence a complaint investigation regarding the allegation listed above. LPA met with Jolene Farish, Executive Director and explained the purpose of the visit and the elements of the allegation. During the investigation, LPA Shaw-Ross conducted interviews with five (5) residents, and five (5) staff members. The investigation also consisted of observation and record review. LPA was unable to interview additional witnesses due to not being able to obtain contact.

On 9/28/2023, Community Care Licensing received a complaint alleging staff did not ensure resident was provided fluids resulting in dehydration. Information obtained from the five residents interviewed, four (4) residents stated that staff is providing plenty of fluids to combat dehydration. One resident (R5) stated they believe they became dehydrated due to the facility not providing enough fluids. LPA also interviewed staff that included Resident Care Director, Resident Care Coordinator and Medtech/Caregiver, all indicated sufficient supply of fluids is available and given to residents at all times. LPA interviewed the Resident Care Coordinator who reported they make it a point to have plenty of water/hydration stations on each floor and when residents are dehydrated they make sure that medtechs and caregivers delivery a variety of fluids to the residents rooms. She also stated during Med pass, they offer additional fluids to residents who are experiencing dehydration. LPA toured the facility and observed water/hydration stations on each floor, however facility staff could not confirm through logs or documents that water was adequately provided to residents.

Based on interviews and observation, the allegation that staff did not ensure resident was provided fluids resulting in dehydration is UNSUBSTANTIATED; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and a copy of this report was provided to Jolene Farish, Executive Director.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross	TELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

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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