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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603625
Report Date: 11/29/2023
Date Signed: 11/29/2023 05:21:28 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
11/22/2023 and conducted by Evaluator Nacole Patterson
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20231122081655
FACILITY NAME:STELLAR CAREFACILITY NUMBER:
374603625
ADMINISTRATOR:LINDA CHOFACILITY TYPE:
740
ADDRESS:4518 54TH STREETTELEPHONE:
(619) 287-2920
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:120CENSUS: 77DATE:
11/29/2023
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator Linda ChoTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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9
Licensee did not administer medication as prescribed.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to initiate and deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Linda Cho, Administrator.

On 11/22/23 it was alleged that the Licensee did not administer medication as prescribed by neglecting to include a resident's full medication regimen for an out-of-facility visit. The Department’s investigation consisted of an unannounced facility visit, review of facility records, and interviews with facility staff, residents, and outside sources. Staff interview did not corroborate the allegation, as no staff advised being aware that the incident occurred, including the named staff witness. Resident interview, including the resident in question, revealed no concerns regarding medication administration at the facility; residents stated they received their medications on time and correctly. Outside sources interviewed did not express concerns regarding medication administration at the facility and informed they had not received any reports regarding it. No records were found to corroborate the allegation.
(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
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 5
Control Number 08-AS-20231122081655
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: STELLAR CARE
FACILITY NUMBER: 374603625
VISIT DATE: 11/29/2023
NARRATIVE
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(Continued from LIC9099)

Based on interviews and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegations is UNSUBSTANTIATED. An exit interview was conducted with Administrator Linda Cho, 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: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
11/22/2023 and conducted by Evaluator Nacole Patterson
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20231122081655

FACILITY NAME:STELLAR CAREFACILITY NUMBER:
374603625
ADMINISTRATOR:LINDA CHOFACILITY TYPE:
740
ADDRESS:4518 54TH STREETTELEPHONE:
(619) 287-2920
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:120CENSUS: 77DATE:
11/29/2023
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator Linda ChoTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not ensure medication was inaccessible to resident.
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to initiate and deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Administrator Linda Cho.

On 11/22/23 it was alleged that the Licensee did not ensure medication was inaccessible to a resident. The Department’s investigation consisted of an unannounced facility visit, review of facility records, and interviews with facility staff, residents, and outside sources. Staff interview revealed that staff were notified of morning medications being left in a resident's room, which staff confirmed by locating the medications and removing them. Staff interview further revealed that the Licensee conducted an internal investigation regarding the error and initiated medication re-training for all Medication Technician staff. Records review revealed that the facility self-reported the incident and made the required notifications. Outside source interviews revealed no knowledge or concerns regarding medication administration at the facility.

(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20231122081655
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: STELLAR CARE
FACILITY NUMBER: 374603625
VISIT DATE: 11/29/2023
NARRATIVE
1
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3
4
5
6
7
8
9
10
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12
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(Continued from LIC9099)

Resident interviews revealed no concerns regarding medication administration; residents informed that their medications were administered timely and correctly.

Based on interviews and records review, the preponderance of evidence has been met that alleged violation occurred, and is therefore substantiated. Deficiencies are cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Administrator Linda Cho, 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: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20231122081655
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: STELLAR CARE
FACILITY NUMBER: 374603625
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/29/2023
Section Cited
CCR
87465(h)(1)(B)
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87465(h)(1) Medications shall be centrally stored under the following circumstances: (B) Any medication is determined by the physician to be hazardous if kept in the personal possession of the person for whom it was prescribed. This requirement was not met, as evidenced by:
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Licensee has started re-training for all Med Tech staff. Licensee will conduct 87465(h)(2) Incidental Medical and Dental Care in-service training and provide proof to the Department via sign-in sheets, by the POC due date.
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Based on records review and interviews, Licensee did not ensure prescribed medication was kept out of personal possession to a resident (R1). This posed a health and safety risk to 1 of 77 persons 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) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5