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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601005
Report Date: 10/18/2021
Date Signed: 10/19/2021 02:54:40 PM



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
10/14/2021 and conducted by Evaluator Elizabeth Hamilton
COMPLAINT CONTROL NUMBER: 08-AS-20211014101722
FACILITY NAME:VETERANS HOME CHULA VISTAFACILITY NUMBER:
374601005
ADMINISTRATOR:CAROL BRANSHAWFACILITY TYPE:
740
ADDRESS:700 EAST NAPLES COURTTELEPHONE:
(619) 205-1488
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:55CENSUS: 20DATE:
10/18/2021
UNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Administrator, Carol BranshawTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Facility staff physically abused residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced complaint investigation at the facility for the above allegation. LPA met with Administrator, Carol Branshaw and was granted entry after identifying herself. LPA explained the purpose of the visit.

During today's visit, LPA requested and reviewed resident, staff and facility records, conducted interviews with residents and Administrator and briefly toured the facility.

It was alleged on or around October 2021, staff physically abused residents in the Residential Facility for the Elderly (RCFE). Interview with Administrator revealed resident 1 (R1 – See LIC 811 – Confidential Names List) had never resided at the RCFE.

Continued on next page (LIC 9099C)
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021
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-20211014101722
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: VETERANS HOME CHULA VISTA
FACILITY NUMBER: 374601005
VISIT DATE: 10/18/2021
NARRATIVE
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Further investigation revealed the incident was reported incorrectly under the RCFE and the alleged incident occurred at the Skilled Nursing area collocated on the larger campus. The California Department of Social Services (CDSS) Community Care Licensing Division (CCLD) does not have jurisdiction over Skilled Nursing Facilities (SNF), therefore the above allegation is determined to be Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. LPA Hamilton will cross-report to the California Department of Public Health.

An exit interview was conducted with Administrator, Carol Branshaw and a copy of this report, LIC 811, Licensee Appeal Rights (LIC 9058) was provided via email. An electronic receipt of confirmation was requested to be sent by the Licensee upon receipt of the documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2