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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603402
Report Date: 08/24/2022
Date Signed: 08/24/2022 11:26:32 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
08/15/2022 and conducted by Evaluator Ramon Serrano
COMPLAINT CONTROL NUMBER: 08-AS-20220815153112
FACILITY NAME:FREDERICKA MANORFACILITY NUMBER:
374603402
ADMINISTRATOR:CRAIG SUMNERFACILITY TYPE:
740
ADDRESS:183 THIRD AVENUETELEPHONE:
(619) 205-4100
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:560CENSUS: 249DATE:
08/24/2022
UNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Corinna NortonTIME COMPLETED:
11:38 AM
ALLEGATION(S):
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Facility did not meet resident's nutritional needs.
Facility did not keep resident hydrated.
Facility did not communicate with responsible party appropriately.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ramon Serrano, conducted an unannounced Complaint Visit. LPA introduced himself and discussed the purpose of the visit with Director of Resident Services Corinna Norton.

During today's visit, a record review revealed the alleged victim is residing in the Skilled Nursing section of the facility. The San Diego Regional Office (SDRO) Community Care Licensing (CCL) Division 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. We have therefore dismissed the complaint. LPA Serrano will cross-report to the California Department of Public Health.

An exit interview was conducted with Corinna Norton. A copy of this report along with licensee rights (LIC 9098, 01/16) was provided to Corinna Norton whose signature below verifies receipt of these rights.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Ramon SerranoTELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
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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