374604060-1-23-2023-08-AS-SJAB-CNKUPE-20230130144526

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604060
Report Date: 01/20/2023
Date Signed: 01/23/2023 07:02:57 AM

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
09/10/2020 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20200910151524

FACILITY NAME:	GROSSMONT GARDENS		FACILITY NUMBER:	374604060
ADMINISTRATOR:	KAITLIN RUDOLPH		FACILITY TYPE:	740
ADDRESS:	5480 MARENGO AVE		TELEPHONE:	(619) 463-0281
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	425	CENSUS: 201	DATE:	01/20/2023
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Executive Director (ED) Lane Hermosillo		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Financial abuse of resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigated findings on the above-mentioned allegation. LPA identified herself and discussed the purpose of the visit and the elements of the allegation with Executive Director (ED) Lane Hermosillo.

The Department’s investigation consisted of outside source interviews. It also consisted of outside source and a resident records review.

It was alleged when Resident1 (R1) was financially abused while residing at the facility. A resident record review revealed R1 was admitted to the facility in 2013, and at the time of the complaint R1 was very independent, able to perform their own ADL’s, and leave the facility unassisted. An interview with an Outside Source (OS1) corroborated R1 was self-sufficient and, prior to the COVID-19 quarantine, drove their own car as needed and/or desired, and lived in the independent unit of the facility.

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: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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-20200910151524

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	FACILITY NUMBER: 374604060
	VISIT DATE: 01/20/2023

NARRATIVE

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The interview also revealed R1 lived at the facility for several years with no issues and was always treated well by facility staff. OS1 was not aware a complaint was filed with CCL.

The interview with OS1 also revealed it was R1 who discovered the questionable transactions on their bank statement, and the transactions were made through their ATM card that R1 never lost possession of. R1 filed 3 claims with their bank, and notified OS1, and there was a police report filed. OS1 and an Outside Source (OS2) interviews also revealed R1's bank conducted an internal investigation and R1 was reimbursed by the bank. The interview with OS2 revealed R1's internal bank investigation on the fraudulent transactions resulted in R1 being reimbursement but yielded no suspect information. An additional Outside Source (OS3) record review regarding the allegation also yielded no suspect information.

Based on interviews and records review the allegation was determined to be unsubstantiated. An unsubstantiated finding means although the allegation may have occurred the preponderance of the evidence standard has not been met.

An exit interview was conducted with ED Hermosillo and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided . Signature of this form confirms receipt 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: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC9099 (FAS) - (06/04)

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