374604060-10-19-2022-08-AS-LTEZ-CKQN6Y-20221031101151

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604060
Report Date: 10/18/2022
Date Signed: 10/19/2022 08:43:29 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
10/11/2022 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20221011160727

FACILITY NAME:	GROSSMONT GARDENS SENIOR LIVING		FACILITY NUMBER:	374604060
ADMINISTRATOR:	LANE HERMOSILLO		FACILITY TYPE:	740
ADDRESS:	5480 MARENGO AVE		TELEPHONE:	(619) 463-0281
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	425	CENSUS: 201	DATE:	10/18/2022
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Executive Director, Lane Hermosillo		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff did not adhere to admission agreement

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegations mentioned above with Executive Director, Lane Hermosillo.

During today's visit, LPA briefly toured the facility, requested records, and interviewed staff. It was alleged staff did not adhere to admission agreement for a resident. It was reported a bill was received for services rendered at the facility. Outside source interviews revealed the resident does not want certain services provided by the facility not to include basic services. According to outside source interviews, there was a misunderstanding. The facility did not bill the resident for services rendered at the facility, instead the resident was billed by their insurance company for some needed tests. Staff adhered to the admission agreement. ED explained the facility uses a third party vendor for covid testing, at no charge to the resident. Residents completed consent for the testing. Facility also had Antigen tests available at no cost. ED stated admission agreement has an option to chose in house or outside vendor services. ED explained residents are not required to use the facility's optional services.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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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Control Number 08-AS-20221011160727

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: GROSSMONT GARDENS SENIOR LIVING	FACILITY NUMBER: 374604060
	VISIT DATE: 10/18/2022

NARRATIVE

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This agency has investigated the complaint alleging staff did not adhere to admissions agreement. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Executive Director, Lane Hermosillo whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC9099 (FAS) - (06/04)

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