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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600823
Report Date: 12/23/2024
Date Signed: 12/23/2024 02:48:49 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/20/2024 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20241220085937
FACILITY NAME:HILLSIDE GARDEN RCFEFACILITY NUMBER:
374600823
ADMINISTRATOR:JASNA POPOVICHFACILITY TYPE:
740
ADDRESS:4892 HILLSIDE DRIVETELEPHONE:
(760) 730-3800
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:6CENSUS: DATE:
12/23/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Caregiver Ernesto Aldana and Managers David Swagerty and Marko KolomijcevTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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-Licensee’s staff neglected resident's needs at night.
-Licensee’s staff did not treat resident with dignity.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to commence a Complaint Investigation regarding the above allegations. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Ernesto Aldana. LPA then met with Managers David Swagerty and Marko Kolomijcev, who arrived later during the visit.

The Complainant alleged that Licensee’s staff neglected Person #1’s (P1) care needs at night, and the Licensee’s staff did not treat P1 with dignity. CCLD’s investigation involved an unannounced facility tour/welfare check and a collateral visit. LPA also reviewed pertinent records and interviewed relevant residents, staff, and outside sources.


[CONTINUED ON LIC 9099]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
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 2
Control Number 08-AS-20241220085937
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: HILLSIDE GARDEN RCFE
FACILITY NUMBER: 374600823
VISIT DATE: 12/23/2024
NARRATIVE
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[CONTINUED FROM LIC 9099]

Interviews of P1 and facility staff, corroborated by administrative records, unanimously showed: P1 was not a resident of the RCFE, either during the complaint period or currently. Rather, P1 was a tenant of an Independent Living Facility (ILF) which is attached to the RCFE premises, but which is not part of the Hillside Garden RCFE which is licensed by CCLD.

During today’s visit, LPA also visited each of the six (6) residents in care at the RCFE, interviewing all those who were capable of being interviewed. LPA also interviewed multiple managers and multiple direct care staff of the RCFE.

Based on records and interviews, a preponderance of evidence does not exist to show that Licensee’s staff neglected resident needs at night, or that Licensee’s staff did not treat residents with dignity. Both allegations are therefore Unsubstantiated, and no deficiencies were cited for them.

An exit interview was conducted with Swagerty. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided to the Licensee during today’s visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2