374603625-9-30-2021-08-AS-SJAB-C7JM6J-20211006091958

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603625
Report Date: 09/29/2021
Date Signed: 09/30/2021 09:53:08 AM

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
04/07/2020 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20200407154133

FACILITY NAME:	STELLAR CARE		FACILITY NUMBER:	374603625
ADMINISTRATOR:	LINDA CHO		FACILITY TYPE:	740
ADDRESS:	4518 54TH STREET		TELEPHONE:	(619) 287-2920
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	120	CENSUS: 76	DATE:	09/29/2021
		UNANNOUNCED	TIME BEGAN:	04:07 PM
MET WITH:	Administrator, Linda Cho		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

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Facility refused to accept residents back to facility after hospitalization.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Correia conducted an unannounced visit to deliver investigative findings on the above listed complaint allegation. LPA was met and granted entry into the facility by Administrator Linda Cho and explained the reason for the visit.

The Department’s investigation consisted of staff, outside source interviews, and record reviews.

It was alleged that Resident 1 (R1) and Resident 2 (R2) (See Confidential Names List LIC 811) were not allowed to return to the facility after being hospitalized resulting in a positive COVID-19 diagnosis. In response to the emerging pandemic, on March 4, 2020 Governor Newsome issued a Proclamation of a State of Emergency (PIN # 20-04-CCLD) under item #14, permitting Community Care Licensing (CCL) Department of Social Services (DSS) to waive any provision under the Health and Safety Code (HSC) 1569 et seq., deemed necessary to respond to the threat of COVID-19. On March 31, 2020 Administrator Cho reported two COVID-19 cases to CCL and requested guidance on proper care and infection control. Facility records revealed that the Administrator was in daily communication with Regional Office during this time to provide guidance and ensure proper placement for both R1 and R2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

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-20200407154133

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: STELLAR CARE	FACILITY NUMBER: 374603625
	VISIT DATE: 09/29/2021

NARRATIVE

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An interview with Administrator Cho corroborated the review of R2's medical and facility records. The records revealed a history of behaviors that would inhibit the facility from being able to safely quarantine the residents. Licensee stated R2 was able to come back to the facility after the quarantine. However, R2 was relocated to a different facility. In contrary, an interview with an outside source revealed that the facility would not accept R2 back regardless of R2's COVID-19 test result. An interview with an outside source also revealed a facility was identified willing to admit R2. The facility communicated with the Regional Office and R2 was safely relocated to a Board and Care on April 6, 2020. In reference to R1, records revealed upon medical clearance, including a negative COVID-19 test result, R1 returned to Stellar Care on April 12,2020.

Based on interviews, record reviews, and the allowance of waivers due to the Statewide Pandemic there is insufficient evidence to support the allegation that residents were being refused to be allowed back into the facility. With no other corroborating evidence, the finding regarding the above-mentioned allegation was established to be unsubstantiated. This finding means although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

LPA Correia conducted an exit interview with Licensee with Administrator Cho and a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) was provided to Administrator Cho via email. An electronic email read receipt confirms the documents were received.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC9099 (FAS) - (06/04)

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