374604392-7-26-2023-08-AS-SJAB-CU6QE6-20230728120549

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604392
Report Date: 07/26/2023
Date Signed: 07/26/2023 02:03:08 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
05/27/2022 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20220527163855

FACILITY NAME:	VILLALOBOS ARF #3		FACILITY NUMBER:	374604392
ADMINISTRATOR:	VILLALOBOS, ROGER		FACILITY TYPE:	735
ADDRESS:	875 MISTY MEADOW CT.		TELEPHONE:	(619) 778-8469
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	4	CENSUS: 3	DATE:	07/26/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Roger Villalobos		TIME COMPLETED:	02:14 PM

ALLEGATION(S):

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Residents’ medications are being mismanaged

Residents’ documents are being falsified

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Administrator Roger Villalobos and we discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of LPA direct observation, records review, interviews with facility staff and outside agency.

It was reported to CCL that clients' medications were being mismanaged and clients' medication administration records were falsified by staff members. LPA visit to the facility on June 3, 2022 and July 17, 2023 revealed the client medication was stored properly and was both organized and secured. LPA records review for both facility visits revealed the medication administration records (MARs) for each client was properly documented and the clients were receiving medications as prescribed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

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 08-AS-20220527163855

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VILLALOBOS ARF #3	FACILITY NUMBER: 374604392
	VISIT DATE: 07/26/2023

NARRATIVE

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Interview with outside agency revealed no knowledge of any mismanaged medications or any documents being falsified. Outside agency further stated that they have conducted several unannounced visits to the facility and have not witnessed or heard of any medication mismanagement or falsification of records.

Interview with administrator revealed staff are very strict about the issuing and disbursements of medications and the proper documentation. Administrator further stated that the only “mix-up” they had was on May 29, 2023 when a client did not receive their vitamin supplement due to the new medication cycle starting on a Monday (Memorial day morning) and the client was still out visiting their mother. Administrator stated that the mother was notified the following morning and the client was given the supplement that afternoon. In regards to documents being falsified, Administrator stated it is utterly false, since they take great pride in the care and well being of their consumers and the proper documentation is a very important part of their facilities. Administrator further stated that they believe the allegations may be from a disgruntled staff that was caught in the act of sabotaging P&I documents and pulling out important doctors notes from facility files. That particular staff was relieved of their duties and no longer works at the facility.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid.

An exit interview was conducted with Roger Villalobos. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Roger Villalobos whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

LIC9099 (FAS) - (06/04)

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