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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604353
Report Date: 12/20/2021
Date Signed: 12/20/2021 01:45:41 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/23/2021 and conducted by Evaluator Carmen Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20210223113039
FACILITY NAME:MAJELLA ASSISTED LIVING, LLCFACILITY NUMBER:
374604353
ADMINISTRATOR:MORRISON, JIMFACILITY TYPE:
740
ADDRESS:2590 MAJELLA RD.TELEPHONE:
(760) 216-6344
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:12CENSUS: 10DATE:
12/20/2021
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Jim Morrison, LicenseeTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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- Facility did not provide residents with hot water.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Carmen Lopez, conducted an unannounced visit to the facility to deliver findings for a complaint investigation regarding the above-mentioned allegation. LPA Lopez identified herself and was granted entry by Karina Sanchez, Caregiver. LPA met with Jim Morrison, Licensee and stated the purpose of the visit.

The Department’s investigation consisted of verifying water temperatures, interviews with staff, residents and an outside source pertinent to this investigation.

On February 23, 2021, it was alleged that the facility did not have hot running water in one of the facility restrooms the residents used for bathing and personal care. Interviews with residents revealed that the hot water was not working on the upper level restroom of the facility. Interview with an outside source confirmed that hot water in the upper level of the facility was not working. Staff interviews acknowledged that the hot water was not
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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 08-AS-20210223113039
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: MAJELLA ASSISTED LIVING, LLC
FACILITY NUMBER: 374604353
VISIT DATE: 12/20/2021
NARRATIVE
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operable in the upper level restroom and staff had to heat hot water and take it over to the upper level restroom in order to bathe residents. During the investigation, hot water temperatures were taken, and the upper level restroom hot water measured at only 90 degrees Fahrenheit. According to Title 22 regulations, hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degrees and not more than 120 degrees Fahrenheit. Measurement of taps for hot water and interviews with staff, residents and an outside source supported the allegation that the facility did not provide residents with hot water as required.

The Department has investigated the above-mentioned allegation and based upon the evidence obtained, it found that there is sufficient evidence to prove that the allegation occurred. Therefore, the allegation is determined to be substantiated.

The report was discussed with Jim Morrison, Licensee, plan of correction was reviewed, and a copy of this report along with Applicant/Licensee Rights (LIC9058 01/16) was provided to the Licensee via email. An electronic email receipt confirms the documents were received.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20210223113039
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: MAJELLA ASSISTED LIVING, LLC
FACILITY NUMBER: 374604353
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2021
Section Cited
CCR
87303(e)(2)
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87303(e)(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. ... This regulation was not met as evidence by:
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Facility made repairs June 2021 which repaired the hot water temperature. LPA took temperatures for the restroom in question and temperatrures were in range. POC was cleared 12/20/21.
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Based on interviews and hot water temperature taps of the facility bathroom did not measure within regulation. This posed a potential threat to eight out of ten 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: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3