374603625-11-29-2023-08-AS-JLOT-CYYUJY-20231229143819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603625
Report Date: 11/29/2023
Date Signed: 11/29/2023 05:23:38 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
10/27/2023 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20231027145433

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: 77	DATE:	11/29/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Administrator Linda Cho		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Licensee did not provide resident with a 60 day notice of fee increase.
Licensee charged unlawful additional fee.
Licensee did not assess resident for a higher level of care.
Licensee did not ensure resident's shower was clean.
Licensee did not meet food service requirements.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Administrator Linda Cho.

On 10/27/23 it was alleged that the Licensee did not provide a resident with a 60 day notice of fee increase, Licensee charged an unlawful additional fee, Licensee did not assess a resident for a higher level of care, Licensee did not ensure a resident's shower was clean, and Licensee did not meet food service requirements. The Department’s investigation consisted of unannounced facility visits, review of facility and outside source records, interviews with facility staff, residents, outside sources, and LPA direct observations.

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (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)

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Control Number 08-AS-20231027145433

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)

Regarding the allegation, "Licensee did not provide resident with a 60 day notice of fee increase", staff interviews and records review revealed that the increase in question was regarding a level of care increase for a specific medication administration, which does not require 60-days notice. Records review revealed that the Responsible Party (RP) was provided advance notification for the increase and signed in acknowledgement. Records review of the care level notification and subsequent invoices confirmed that the facility provided notification to RP within the Health and Safety Code requirements for a level of care change.

Regarding the allegation, "Licensee charged unlawful additional fee", it was alleged that the Licensee did not notify a Responsible Party (RP) of a level of care increase. Staff interview revealed that the increase was due to a change in Resident 1 (R1)'s care needs, and the RP was provided notice of the increase per requirements. Records review confirmed that RP was provided written notification of the care fee increase within the required timeframe. Records review and staff interview further revealed documented and consistent accounts of services rendered that justified the increase. Outside sources did not corroborate the allegation and did not express concerns regarding the facility adhering to fee increase notification requirements.

Regarding the allegation, "Licensee did not assess resident for a higher level of care", it was alleged that Resident 2 (R2) was not properly assessed by the Licensee. Staff interview revealed that the behaviors and services rendered for R2 were consistent with their most recent appraisal, and common among memory care residents. Staff members interviewed consistently stated that the behaviors exhibited by R2 were appropriate to the level of care they had received. Records review revealed that the most recent appraisal for R2 was within the required assessment timelines, according to regulation. No records reviewed gave evidence to a significant change in behavior that would require a reappraisal and/or level of care change for R2. LPA directly observed R2 during an unannounced facility visit and observed them to show behaviors consistent with other residents receiving the same level of care. Outside source interviews did not corroborate the allegation and did not express concern regarding the Licensee's reappraisal process for residents and the assessments used to justify levels of care.

(Continued on LIC9099-C)

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (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)

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Control Number 08-AS-20231027145433

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-C)

Regarding the allegation, "Licensee did not ensure resident's shower was clean", it was alleged that staff did not maintain the cleanliness of a resident's shower. Records review revealed that the shower in question was deep cleaned every Monday, on a weekly basis. Staff interview revealed that housekeeping staff deep clean resident showers weekly, and rinse showers out on a daily basis. Staff members interviewed consistently confirmed observing housekeeping staff cleaning bathrooms and showers according to the schedule and did not observe any resident shower being left dirty. LPA directly observed the shower in question and observed it to be without debris, soap scum, or any other substance that would indicate that it was not being cleaned according to the schedule. Outside sources interviewed did not corroborate the allegation and did not express concern regarding the cleanliness of resident bathrooms at the facility.

Regarding the allegation, "Licensee did not meet food service requirements", it was alleged that Licensee served food to residents that was flavorless and without variety. Staff interview revealed that residents are offered meals based on a 5-week rotating menu; the facility also offers an every day menu of 5 alternate food options for lunch and dinner. Staff interview revealed that residents without sodium restrictions are provided salt, pepper, and condiments at their table during dining services. Staff interview further revealed that the Dining Director was aware of all food restrictions, and specific accommodations to residents' cultural, dietary, and personal preferences were accounted for during each meal. Outside sources did not corroborate the allegation and advised no concerns regarding the quality and variety of food served at the facility.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation(s) occurred, therefore the allegations are 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 Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (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)

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