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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803704
Report Date: 12/22/2022
Date Signed: 12/22/2022 03:35:14 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2022 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20220825152412
FACILITY NAME:VISTA PRADO INCFACILITY NUMBER:
486803704
ADMINISTRATOR:GODFREY, TEDRAFACILITY TYPE:
740
ADDRESS:105 POWER DRIVETELEPHONE:
(707) 643-7617
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY:68CENSUS: 30DATE:
12/22/2022
UNANNOUNCEDTIME BEGAN:
11:41 AM
MET WITH:Adiam Welday, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Unlawful Eviction
INVESTIGATION FINDINGS:
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On 12/22/2022 Licensing Program Analyst, (LPA) Tobola conducted an unannounced visit for the purpose of delivering complaint investigation findings. LPA Tobola conducted a tour of the facility, reviewed resident records, interviewed staff and outside parties and made observations.

The complaint alleges that an unlawful eviction was imposed on resident (R1) by the facility for refusing to accept resident back into care from medical center. Based on interviews with Administrator and Health Services Director, LPA found that the facility did not choose to accept resident (R1) back into care when medical discharge was declared by physician after R1's medical surgery. Based on interviews with outside parties (I1 & I2), LPA found that R1 had been medically cleared to return to the facility on 8/23/2022 but was not fully discharged until 9/2/2022. I2 stated that facility staff at Vista Prado had not... Continued onto LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic TobolaTELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
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 21-AS-20220825152412
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: VISTA PRADO INC
FACILITY NUMBER: 486803704
VISIT DATE: 12/22/2022
NARRATIVE
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responded to several calls from 8/23/2022-8/28/2022 to complete the discharge process for R1. I2 also stated that the facility's reason for not accepting R1 was due to concerns of R1 re-inuring themselves.

Upon review of R1's Physician's Reports LIC602, prior to and after R1's surgery, LPA found that R1 had been diagnosed from ambulatory to non-ambulatory and required toileting assistance. However, LPA found that no additional levels care were required for R1 that the facility could not meet based on restricted health conditions. Although R1 was determined non-ambulatory upon discharge, the facility is still to provide basic activities of daily living (ADL) care and based on Title 22 regulations, not a valid reason to refuse accepting R1 back under the facility's care.

Based on a tour of the facility, interviews with staff and outside parties, review of resident records and observations, the allegation, facility imposed unlawful eviction is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D. Appeal Rights Given.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic TobolaTELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20220825152412
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: VISTA PRADO INC
FACILITY NUMBER: 486803704
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/23/2022
Section Cited
CCR
87468.2(a)(20)
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87468.2(a)(20) Additional Personal Rights of Residents:

To be protected from involuntary transfers, discharges, and evictions. A licensee shall not involuntarily transfer or evict residents for reasons other than those permitted by state law or regulations and shall comply with all eviction and relocation protections for residents. For purposes of this paragraph, "involuntary" means a transfer, discharge, or eviction that is initiated by the licensee, not by the resident.
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The faciltiy is to submit a written statement that staff have reviewed and understand regualation 87468.2. LIC9098 Proof of Corrections along with the written statement is to be submited to CCLD
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This requirement was not met as evidence by:**
Based on interviews with staff and outside parties and review of resident R1's records; it was found that the facility chose not to accept R1 back into the facility's care in a timely manner when R1 had been medically cleared for discharge from R1's physician.
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by Plan of Correction Date 12/23/2022.
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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: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic TobolaTELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3