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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603565
Report Date: 08/08/2025
Date Signed: 08/08/2025 12:04:59 PM

Substantiated


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
10/03/2022 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20221003100925
FACILITY NAME:LA VIDA REALFACILITY NUMBER:
374603565
ADMINISTRATOR:KIMBERLY GARCIAFACILITY TYPE:
740
ADDRESS:11588 VIA RANCHO SAN DIEGOTELEPHONE:
(619) 660-5778
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:177CENSUS: 126DATE:
08/08/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Executive Director Kimberly GarciaTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Lack of supervision resulted in resident being left on the floor for an extended period.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings in the above complaint allegation. LPA identified herself and discussed the purpose of the visit with Executive Director Kimberly Garcia.  

On October 3, 2022, Community Care Licensing (CCL) received a complaint alleging Lack of Supervision to Resident (R1) (R1 – see LIC811 Confidential Names List) resulted in R1 being left on the floor for an extended period. During the investigation, the Department collected records and conducted interviews. Physician’s Report dated March 22, 2021, confirmed R1 was diagnosed with a mild neurocognitive impairment and is ambulatory. R1’s Individual Service Assessment dated August 30, 2022, also established that R1 requires an escort and hand on assistance for mobility.

Details of the allegation state that on September 28, 2022, R1 initiated their nighttime routine, and received medication from Medication Technician at 10:00pm. At about 10:30pm, R1 got up from their couch while using walker and fell sideways.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
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 5
Control Number 08-AS-20221003100925
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: LA VIDA REAL
FACILITY NUMBER: 374603565
VISIT DATE: 08/08/2025
NARRATIVE
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According to R1, R1 called out for help and could not reach their call pendant. R1 stated no one arrived to assist until about 7:30am on September 29, 2022. Interview with multiple training-staff revealed that staff are expected to check all assigned residents’ multiple times per night. Interview with responsible parties revealed that the facility advertised itself to them as checking in on assisted-living residents every two hours. Interview with Director of Assisted Living corroborated that facility staff are to check resident’s multiple times per night. According to records collected, the night of September 28, 2022, Staff 1 (S1) was assigned to R1’s floor. During an interview, S1 stated they did not check in on R1 the night of the incident and S1 had been told that R1 did not require continuous visual checks. Interview with Staff 2 (S2) established that on the morning of September 29, 2022, R1 did not call S2, as usual, for escort assistance to breakfast. S2 stated as they went to check on R1 they heard R1 yelling for help at about 7:10am, S2 stated that when they opened the door, they observed R1 in their room on the floor leaning against the patio door. S2 then proceeded to contact Staff 3 (S3) to assess R1 for injuries; no serious injury was found.

Based on interviews and records collected, a preponderance of evidence exists to support the allegation. The allegation is therefore substantiated. A deficiency is cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Executive Director Kimberly Garcia, and a Plan of Correction was jointly developed. A copy of this report, LIC811, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to xxxxxx, signature on this form confirms receipt of documents. 

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 08-AS-20221003100925
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: LA VIDA REAL
FACILITY NUMBER: 374603565
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/22/2025
Section Cited
CCR
87468.2(a)(4)
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(a) residents in privately operated residential care facilities shall have all of the following...: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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Licensee states they will conduct a re-training on resident monitoring by POC date.
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This requirement was not met as in evidence; Based on interviews and records the licensee did not provide supervision and care to one resident in care (R1) of which posed a potential Health, Safety, and Personal Rights risk to persons 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.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
10/03/2022 and conducted by Evaluator Iby Strong
COMPLAINT CONTROL NUMBER: 08-AS-20221003100925

FACILITY NAME:LA VIDA REALFACILITY NUMBER:
374603565
ADMINISTRATOR:KIMBERLY GARCIAFACILITY TYPE:
740
ADDRESS:11588 VIA RANCHO SAN DIEGOTELEPHONE:
(619) 660-5778
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:177CENSUS: DATE:
08/08/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Executive Director Kimberly GarciaTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff did not seek timely medical attention for resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings in the above complaint allegations. LPA identified herself and discussed the purpose of the visit with Executive Director Kimberly Garcia.  

On October 3, 2022, Community Care Licensing (CCL) received a complaint alleging facility staff did not seek medical care for Resident (R1) (R1 – see LIC811 Confidential Names List) after an unwitnessed fall. During the investigation, the Department collected records and conducted interviews. Physician’s Report dated March 22, 2021, confirmed R1 was diagnosed with a mild neurocognitive impairment and is ambulatory. R1’s Individual Service Assessment dated August 30, 2022, also established that R1 requires an escort and hand on assistance for mobility but is alert and oriented.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20221003100925
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: LA VIDA REAL
FACILITY NUMBER: 374603565
VISIT DATE: 08/08/2025
NARRATIVE
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Details of the allegation state that on September 28, 2022, R1 initiated their nighttime routine, and received medication from Medication Technician at 10:00pm. At about 10:30pm, R1 got up from their couch while using walker and fell sideways. According to R1, R1 called out for help and could not reach their call pendant. R1 stated no one arrived to assist until about 7:30am on September 29, 2022. Interview with Staff 2 (S2) established that on the morning of September 29, 2022, R1 did not call S2, as usual, for escort assistance to breakfast. S2 stated as they went to check on R1 they heard R1 yelling for help at about 7:10am, S2 stated that when they opened the door, they observed R1 in their room on the floor leaning against the patio door. S2 then proceeded to contact Staff 3 (S3) to assess R1 for injuries. Interview with S3 established that S3 did a full body check of R1 and found no abnormalities. S3 stated that R1 did not express any pain and was given an as needed pain medication and an ice pack.

Based on LPA's interviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Executive Director Kimberly Garcia to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.







SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5