<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604608
Report Date: 07/22/2024
Date Signed: 07/22/2024 11:26:15 AM


Document Has Been Signed on 07/22/2024 11:26 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:VIBRANT LIVING IIFACILITY NUMBER:
374604608
ADMINISTRATOR:NORRIS, JULIEFACILITY TYPE:
740
ADDRESS:6140 CRAWFORD STREETTELEPHONE:
(619) 929-1730
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY:6CENSUS: 6DATE:
07/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Natalia Lazcano, Caregiver and Julie Norris, AdministratorTIME COMPLETED:
10:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced Case Management Visit.  LPA was greeted by and met with Natalia Lazcano, Caregiver to discuss the purpose of the visit.  Administrator, Julie Norris later arrived and met with LPA. Today's visit is in response to a self reported incident.

According to a submitted LIC624 Unusual Incident/Injury Report, on 07/08/2024, staff heard a noise and observed Resident 1 (R1) on their bedroom floor complaining of pain to their wrist. Staff noted R1's left wrist was swollen. On 7/9/24, an outside agency requested a x-ray be taken of R1's wrist.

On 7/12/2024, staff again observed R1 on the floor of their bedroom. According to the report, R1 had an unwitnessed fall. R1 reportedly told staff that they hit their head. An outside agency performed a mobile x-ray of R1's wrist. The results of the examination determined R1's left wrist was fractured.

During the visit, LPA contacted an outside agency source, requested copies of facility and outside agency records and interviewed facility staff. No health or safety issues were identified.  

No deficiencies were observed or cited during the visit.

*Facility staff advised LPA that R1 passed away on July 17, 2024. Staff stated they will ensure the appropriate reporting is submitted to CCLD.

An exit interview was conducted with Administrator, Norris, who was provided with a copy of this report and Appeal Rights (LIC9056 03/22).  Their signature confirms receipt of these documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1