374602179-1-3-2024-08-AS-SJAB-D4NKG9-20240425075308

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602179
Report Date: 01/03/2024
Date Signed: 01/03/2024 03:38:54 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
09/23/2020 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20200923122416

FACILITY NAME:	TENDER LOVING CARE GUEST HOME		FACILITY NUMBER:	374602179
ADMINISTRATOR:	VICTORIA S. LEGASPI		FACILITY TYPE:	740
ADDRESS:	1430 SHERYL LN		TELEPHONE:	(619) 399-3552
CITY:	NATIONAL CITY	STATE: CA	ZIP CODE:	91950
CAPACITY:	6	CENSUS: 5	DATE:	01/03/2024
		UNANNOUNCED	TIME BEGAN:	10:17 AM
MET WITH:	Victoria Legaspi Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Licensee is retaining a resident who requires a higher level of care.

Licensee does not provide a comfortable temperature for resident.

Resident has sores possibly due to neglect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver the finding in the above mention complaint allegations. LPA Domingo identified herself and discussed the purpose of the visit with Administrator Victoria S. Legaspi.

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

It was alleged that the Licensee was retaining a resident who requires a higher level of care. LPA Domingo observed 3 Residents at the facility. Resident 1 (R1) through Resident 3 (R3) (See LIC811 Confidential Names list), was observed ambulating without any assistance and able to communicate needs. R1 through R3 Physician's report was reviewed and the report accurately reflected R1 through R3 abilities to complete activities of daily living, ability to communicate and ambulate.
[Continue on LIC9099C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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-20200923122416

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: TENDER LOVING CARE GUEST HOME	FACILITY NUMBER: 374602179
	VISIT DATE: 01/03/2024

NARRATIVE

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[Continued from LIC9099]

It was alleged that the Licensee does not provide a comfortable temperature for residents. LPA Domingo observed the temperature at 70 degrees Fahrenheit. R1 through R3 were interviewed and none of the Resident's had any complaints of the temperature of the facility being uncomfortable. Outside source 1 (OS1) was interviewed and there were no complaints with the temperature of the facility.

It was alleged that a Resident has sores possibly due to neglect. Records were reviewed of residents at the facility and no residents had any documentation of sores. Interview with Staff 1 (S1) concurred with records that no residents have any sores. R1 through R3 were interviewed and verbalized they had no sores.

Based on LPA's interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Licensee , to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC9099 (FAS) - (06/04)

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