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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603120
Report Date: 02/07/2024
Date Signed: 02/07/2024 12:49:20 PM

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
02/02/2024 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20240202135810
FACILITY NAME:GARDENS, THEFACILITY NUMBER:
374603120
ADMINISTRATOR:COOPER, DAVIDFACILITY TYPE:
740
ADDRESS:4380 HIGHLAND DRIVETELEPHONE:
(760) 729-1411
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:15CENSUS: 12DATE:
02/07/2024
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Caregiver Elsa ToverTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Licensee placed video camera without permission
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced visit to initiate a complaint investigation. The LPA introduced himself and disclosed the purpose of the visit to Caregiver Elsa Tover.

Throughout the investigation, the Department secured pertinent records and conducted interviews with external and internal sources.

It was alleged a Licensee placed a video camera without permission. Interviews with internal sources revealed there were two cameras in two residents’ bedrooms. One was non-operational and the second camera was linked to a monitor in the kitchen area displaying a live image. During the visit, the LPA observed both cameras in resident bedrooms and confirmed one was operational displaying a live image. Review of the facility file and records revealed the licensee had not submitted and updated Plan of Operation addressing video surveillance, nor submitted a waiver request.
Substantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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 3
Control Number 08-AS-20240202135810
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: GARDENS, THE
FACILITY NUMBER: 374603120
VISIT DATE: 02/07/2024
NARRATIVE
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The deficiency was cited in accordance with California Code of Regulations, Title 22, and listed on the LIC 9099D. A plan of correction was jointly formulated with Administrator David Cooper over the phone.

An exit interview was conducted with Caregiver Elsa Tover, to whom a copy of this report, LIC 9099D, and Licensee/Appeals Rights (LIC 9058),were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20240202135810
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: GARDENS, THE
FACILITY NUMBER: 374603120
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/07/2024
Section Cited
CCR
87468.1(a)(1)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement was not met as evidenced by:
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Administrator and caregiver agreed to remove the camera and monitor in question. LPA observed the camera and monitoer were removed, therefore, the POC was cleared on today's date.
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Based on review of records, interviews, and observations, the license did not ensure reasonable level of privacy when placing a camera, which posed a potential personal rights risk to 1 of 12 residents in care.
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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.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3