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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601005
Report Date: 03/08/2024
Date Signed: 03/08/2024 10:35:51 AM

Unfounded


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
03/06/2024 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20240306153547
FACILITY NAME:VETERANS HOME CHULA VISTAFACILITY NUMBER:
374601005
ADMINISTRATOR:KATHRYN GABRIELFACILITY TYPE:
740
ADDRESS:700 EAST NAPLES COURTTELEPHONE:
(619) 205-1150
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:55CENSUS: 20DATE:
03/08/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Kathy GabrielTIME COMPLETED:
10:40 AM
ALLEGATION(S):
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9
Licensee did not protect a resident from abuse.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to conduct a complaint investigation regarding the above allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Kathy Gabriel.

It was alleged that Licensee did not protect Resident #1 (R1) from the abuse of Resident #2 (R2).

CCLD’s investigation involved an un unannounced facility tour/welfare check, as well as collateral visits to other locations. The Department also reviewed pertinent administrative records and interviewed relevant facility staff and outside sources.

[CONTINUED ON LIC 9099-C]
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
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-20240306153547
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: 03/08/2024
NARRATIVE
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[CONTINUED FROM LIC 9099]

Records, interviews, and LPA observation unanimously showed: Neither R1 nor R2 were residents of the CDSS-licensed facility, either at present or during the time frame of the complaint allegation.

Based on records and interviews, the allegation against Licensee is Unfounded, meaning it was false, could not have happened, and/or is without a reasonable basis. We have therefore dismissed the allegation.

An exit interview was conducted with the Gabriel, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2