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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604060
Report Date: 12/23/2022
Date Signed: 12/24/2022 09:15:03 PM

Unsubstantiated


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
12/01/2022 and conducted by Evaluator Liliana Silveira
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20221201105120
FACILITY NAME:GROSSMONT GARDENS SENIOR LIVINGFACILITY NUMBER:
374604060
ADMINISTRATOR:LANE HERMOSILLOFACILITY TYPE:
740
ADDRESS:5480 MARENGO AVETELEPHONE:
(619) 463-0281
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:425CENSUS: 212DATE:
12/23/2022
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Stacy Tinoco, Health Services DirectorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Licensee did not ensure signal system was in operating condition.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Liliana Silveira conducted a complaint investigation visit to deliver findings for the above-mentioned allegation. LPA Silveira met with Stacy Tinoco, Health Services Director and shared the findings.

The Department’s investigation consisted of observations, interviews and records review. On 12/01/22, it was alleged that the Licensee did not ensure the signal system was in operating condition. A tour of the facility conducted on 12/01/22 revealed that while the signal system was not operating due to technical difficulties, a technician had been hired and was present at the facility working on the system. During the facility tour, it was also observed that large cowbells were provided to residents to signal for assistance and extra care staff were assigned to the area to address any resident care needs.

A records review revealed that responsible relatives were informed about the issue timely and technicians were hired timely to address the problem. Interviews with residents and outside sources also revealed that there were no concerns with the temporary signal system nor were there reported issues of resident needs not being attended to. (CONTINUED ON LIC 9099-C)


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2022
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 2
Control Number 08-AS-20221201105120
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: 12/23/2022
NARRATIVE
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Due to lack of corroborating evidence, the findings regarding the above allegation were established to be unsubstantiated. This finding means that 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 Silveira conducted an exit interview with Stacy Tinoco. At the time of the exit interview Stacy was provided with a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) and signature on this report acknowledges receipt of the rights.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2