374603750-4-24-2025-08-AS-SJAB-DG8UKS-20250430153936

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603750
Report Date: 04/24/2025
Date Signed: 04/24/2025 12:20:21 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
06/08/2022 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20220608130716

FACILITY NAME:	VILLA LORENA		FACILITY NUMBER:	374603750
ADMINISTRATOR:	COLLADO JR, JOSE		FACILITY TYPE:	740
ADDRESS:	14740 VIA FIESTA		TELEPHONE:	(858) 756-9600
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92127
CAPACITY:	85	CENSUS: 63	DATE:	04/24/2025
		UNANNOUNCED	TIME BEGAN:	12:01 PM
MET WITH:	Administrator Nora Garza.		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Licensee did not allow resident to have visitors.
Licensee did not safeguard resident's belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Rodgers made an unannounced visit to deliver findings on the above-mentioned allegation. LPA identified herself and disclosed the purpose of her visit with Administrator Nora Garza.

On June 6, 2022, Community Care Licensing (CCL) received a complaint alleging that the Licensee did not allow Resident #1(R1) visitors and that the Licensee did not safeguard R1's belongings. During the investigation, LPA briefly toured the facility, requested records, and interviewed staff and outside sources.

The review of the physicians report (dated 7/14/2021) reveals R1 has some impairment in hearing and is legally blind. R1 was an assisted living resident. Records review indicate R1 has a history of paranoia and distrust. Interview with staff indicate that R1 has a history of confusion and disorientation. (Continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025

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-20220608130716

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: 04/24/2025

NARRATIVE

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(Continued from 9099)

Regarding the allegation, the Licensee did not allow R1 visitors. More specifically, staff denied visitation to R1 on their birthday, despite proof of vaccination provided. Outside Source #1(OS1) stated they tried to visit R1 on their birthday but were denied entry and recalls it was due to COVID-19 screening issues with the facility. OS1 interview further reveals they were allowed entry in the facility to visit to R1 during previous visits. Interviews with the Manager on Duty during the time period states R1 was showing signs of agitation that day, and they did ask R1 if they wanted visitors. Interview further reveal R1 stated they did not want visitors that day. Outside Source #2(OS2) and outside source #3(OS3) inter

views reveal they never observed any visitors being denied entry nor have heard any complaints about visitors not being able to visit the residents of the facility.

Regarding the allegation, the Licensee did not safeguard the R1's belongings. More specifically, R1's passport and two purses are missing. Interviews with the Former Business Office Director reveal the facility discourages any valuables brought to facility. They also state they do not recall R1 having valuables or passports. Emergency Personnel report (dated 6/6/2022) can not confirm or deny any items were taken from R1’s room. However, during the search, the officer was able to locate one purse under the bed and three missing glasses, but was unable to locate a beaded and purse that was one of the items R1 reported missing. The officer also noted that, while speaking with R1, they would have mood alterations and become argumentative. Based on evidence obtained from interviews, observations and records reviewed, no corroborating evidence was obtained to indicate the facility failed to safeguard a client’s belongings.

Based on the Department's investigation, there is not a preponderance of evidence to prove the alleged violation occurred. Therefore, the allegation is unsubstantiated. An exit interview was conducted with Executive Director Nora Garza to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) will be provided at the conclusion of today's visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025

LIC9099 (FAS) - (06/04)

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