374603750-10-30-2024-08-AS-SJAB-DB8QNN-20241121111924

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603750
Report Date: 10/24/2024
Date Signed: 10/30/2024 10:29:05 AM

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
08/20/2024 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20240820121327

FACILITY NAME:	VILLA LORENA		FACILITY NUMBER:	374603750
ADMINISTRATOR:	COLLADO JR, JOSE		FACILITY TYPE:	740
ADDRESS:	14740 VIA FIESTA		TELEPHONE:	(858) 583-8480
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92127
CAPACITY:	85	CENSUS:	DATE:	10/24/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Resident Service Director Maureen Manzon		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility showers do not dispense hot water
Facility has insufficient staffing to meet the needs of residents
Staff use objects to obstruct the doorway in the memory care unit
The alarm in the memory care unit is in disrepair
The facility Administrator is not available a sufficient amount of time to manage the daily operations of the facility
Staff are not adequately trained.
Lack of supervision resulting in resident eloping from the facility

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPA) Amy Rodgers conducted an unannounced visit to deliver findings regarding the above-mentioned allegations. LPA introduced themselves and disclosed the purpose of the visit to Resident Service Director Maureen Manzon.

On 8/20/2024 it was alleged that Licensee did not ensure showers in memory care unit were at complaint temperatures, there is not enough staffing in memory care which resulted in the licensee not meeting the residents needs, the delayed egress alarm in the memory care unit is not working, the memory care director does not respond to help from staff which effects the daily operations of the facility, staff are not properly trained and lack of supervision resulted in a resident in memory care unit eloping from the facility.

The Department’s investigation consisted of unannounced facility visits, interviews with facility staff and outside sources, records review, and LPA observations.
(continued on 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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-20240820121327

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: VILLA LORENA	FACILITY NUMBER: 374603750
	VISIT DATE: 10/24/2024

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
26
27
28
29
30
31
32

[continued from 9099]
Regarding the allegation, facility showers do not dispense hot water in the memory care unit. LPA toured the facility and took water temperatures of showers and facets in the memory care unit on three separate visits in the last three months, as well as the annual visit conducted in February 2024. All faucets used by residents for personal care delivered hot water and were operational. The hot water was complaint with CCLD regulations. Interview with three outside sources also confirm they have not observed any issues with the water temperature in the showers of the residents in the memory care unit.

Regarding the allegations, facility has insufficient staffing to meet the needs of residents which results with memory care residents being placed on the floor. Record reviews of staff shift schedules as well as interviews with outside sources and the resident care directory for the memory care unit reveal there is an adequate number of direct care staff to support each resident's physical, social, emotional, safety and health care needs. LPA observations during unannounced visits and interviews with outside sources reveal no witness to the residents being placed on floor due to lack of supervision.

Regarding the allegation, licensee staff use objects to obstruct the doorway in the memory care unit. Interviews with four outside sources in the memory care unit of the facility as well as the assisted living unit reveal all outdoor and indoor passageways and stairways were kept free of obstruction.

Regarding the alarm in the memory care unit is in disrepair. LPA observed on three visits in three months the fire department approved delayed egress alarm system was working inside as well as the perimeter of the care unit. Interview with outside sources as well as staff reveal no observation of delayed egress not working or in disrepair.

[continued on 9099-C page 2]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 08-AS-20240820121327

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: VILLA LORENA	FACILITY NUMBER: 374603750
	VISIT DATE: 10/24/2024

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
26
27
28
29
30
31
32

[continued form 9099-C]

Regarding the allegation of staff are not adequately trained. Records reveal licensee conducted required title 22 training to staff before staff could work alone with residents. Records reveal monthly in service training to all staff including working with dementia residents, hand washing, residents rights, fall awareness/prevention,ect. The records also indicate drills are conducted for elopement procedure and fire safety.

Regarding the allegations, the facility Administrator is not available a sufficient amount of time to manage the daily operations of the facility. Records reveal administrator staff is scheduled in the memory care unit as well as the assisted living portion of the facility for a sufficient amount of time to satisfy staffing needs. Interviews with staff confirm they are able to reach out to supervising staff when needed.

Regarding the allegation, Lack of supervision resulted in resident elopement from the memory care unit, it was alleged that a resident eloped from the facility due to staff not providing adequate supervision. Record reviewed showed that internal investigation of the incident was conducted, and LPA interviews and record reviews revealed the facility had in place an Absentee Notification Plan/Policy and followed the policy procedure when the elopement took place.

Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations were deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) was provided to Resident Service Director Maureen Manzon whose signature below confirms receipt of these rights.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3