374603750-7-11-2025-08-AS-SJAB-DJPP7K-20250718110403

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603750
Report Date: 07/11/2025
Date Signed: 07/11/2025 04:07:56 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
11/19/2024 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20241119093137

FACILITY NAME:	VILLA LORENA		FACILITY NUMBER:	374603750
ADMINISTRATOR:	MAUREEN C. MANXON,RN		FACILITY TYPE:	740
ADDRESS:	14740 VIA FIESTA		TELEPHONE:	(858) 583-8480
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92127
CAPACITY:	85	CENSUS: 63	DATE:	07/11/2025
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Administrator Nara Garza		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Physical abuse to resident by staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Rodgers met with Administrator Nora Garza to deliver findings on the above-mentioned allegation. LPA identified herself and disclosed the purpose of her visit with Administrator Nora Garza and conducted the meeting via phone call.

On November 14, 2024, Community Care Licensing (CCL) received a complaint alleging that the Resident #1(R1) was physically abused by licensee Staff #1(S1) and sustained injuries as a result of the alleged abuse. [See LIC811 Confidential Name List for identification of select person identifiers used in this report]. The Department’s investigation consisted of an unannounced facility visit, records review, and staff, resident, and outside source interviews.

(Continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025

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-20241119093137

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: 07/11/2025

NARRATIVE

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[Continued from LIC9099]

Review of R1's physician's report revealed that R1 uses a walker to ambulate to help with gait and balance; however, the needs and the service plan revealed that R1 is noncompliant with medical aides. Review of records revealed that R1 was noted to have episodes of increased confusion due to a diagnosis of vascular dementia.

Per record review and staff interviews on November 17, 2025, R1 was receiving assistance from S1 while exiting their room. R1 was agitated and expressed a desire to leave their room to get breakfast at approximately 11:30 PM. S1 attempted to assist R1 back into bed, but R1 swung their arms and struck the doorframe. In the process, S1 grasped R1 by the arms, which may have contributed to the bruises and skin tears observed on R1's hands and arms. A medical technician assessed R1 and provided first aid to R1 at the time of the incident. Interview further reveal that S1 denied handling R1 in a rough manner and stated S1 was trying to protect themselves while also ensuring R1’s safety. Further records review and Staff interview reveal that on 11/9/2024 , R1 had a previous fall sustaining two skin tears on their right knee and excoriation on their right back shoulder. Interviews with staff and review of evidence reveal it is unknown if R1 caused the skin tears on R1's arms.

Based on a review of pertinent records and interviews, the preponderance of the evidence standard was not met to prove physical abuse by staff. The allegations were deemed unsubstantiated.

An exit interview was conducted with Administrator Garza, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail. A reply E-mail or read receipt confirmation was requested from Garza upon receipt of documents.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2025

LIC9099 (FAS) - (06/04)

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