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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604063
Report Date: 11/06/2025
Date Signed: 11/07/2025 09:40:26 AM

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
06/10/2024 and conducted by Evaluator Amy Domingo
COMPLAINT CONTROL NUMBER: 08-AS-20240610135841
FACILITY NAME:MESAVIEW SENIOR ASSISTED LIVINGFACILITY NUMBER:
374604063
ADMINISTRATOR:GENOVEVA GUERREROFACILITY TYPE:
740
ADDRESS:7971 CULOWEE STREETTELEPHONE:
(619) 466-0253
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:30CENSUS: 28DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Ileana Castro Assistant ManagerTIME COMPLETED:
10:40 AM
ALLEGATION(S):
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Staff neglect leading to a resident sustaining a pressure injury
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver the findings in the above-mentioned complaint allegations. LPA Domingo identified herself and discussed the purpose of the visit with Ileana Castro, Assistant Manager.

During the investigation, LPA Domingo collected pertinent resident records as well as facility documentation and conducted interviews with staff, residents, and outside sources.

On June 10, 2024, the department received a complaint alleging staff neglect, leading to a resident sustaining a pressure injury.


(Continue on LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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 3
Control Number 08-AS-20240610135841
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: MESAVIEW SENIOR ASSISTED LIVING
FACILITY NUMBER: 374604063
VISIT DATE: 11/06/2025
NARRATIVE
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(Continued from LIC9099)

During the interview, staff indicated that multiple facsimile transmissions were sent to the medical organization responsible for managing Resident 1’s healthcare, informing them of the resident’s skin condition. The staff was awaiting direction from the medical team.

Outside Source 1 (OS1) reported that pressure ulcers were identified during a routine visit. OS1 stated they had not been informed of any skin integrity concerns before the visit, nor had they received any documentation indicating that Resident 1 (R1) was experiencing skin issues..

Review of facility records revealed that a physician’s report dated February 26, 2024, documented that Resident 1 (R1) was non-ambulatory, diagnosed with dementia, and required total assistance with all activities of daily living. No family member or responsible party was listed. The first facsimile to R1’s health management team, describing the resident’s skin condition, was sent on May 28, 2024. Subsequent facsimiles were sent on May 29, June 3, June 5, and June 7, 2024. Facility records do not indicate any response received from the health management team regarding these communications. The facility policy states that if the facility is unable to care for a resident because of a change of condition the resident should be sent to the hospital for evaluation and treatment.

There was no indication in R1’s care plans that the resident was receiving treatment for any skin-related conditions. Additionally, the care plans did not include interventions for repositioning while the resident was in bed or seated in a wheelchair to alleviate pressure and prevent further skin breakdown.

The Department has investigated a complaint with the above allegation. The Department has found that there is a preponderance of evidence to prove that the alleged violation did occur; therefore, the allegations are substantiated. An exit interview was conducted with Ileana Castro, Assistant Manager, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20240610135841
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: MESAVIEW SENIOR ASSISTED LIVING
FACILITY NUMBER: 374604063
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/20/2025
Section Cited
CCR
87465(a)(1)
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Facilities must ensure a plan for medical care, and residents receive the necessary medical care for their conditions and needs of residents.

This requirement was not met as evidence by;
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The Facility agrees to conduct a training on Incidental medical care by a CCLD verified vendor by the agreed date of 11/20/25
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Based on observations, interviews and records reviewed that one (1) out of twenty-eight (28) the licensee did not receive the necessary medical care for their condition
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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: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3