374604060-6-15-2023-08-AS-DPOL-CT9PMJ-20230629112624

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604060
Report Date: 06/15/2023
Date Signed: 06/15/2023 01:44:34 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
10/06/2022 and conducted by Evaluator Esther Miller

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20221006140915

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: 218	DATE:	06/15/2023
		UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Reggie Jones, Executive Director		TIME COMPLETED:	10:14 AM

ALLEGATION(S):

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Staff restrained resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced complaint investigation visit to the facility in order to deliver findings on the above allegation. LPA was granted entry to the facility by Reggie Jones, Executive Director, after identifying herself and explaining the reason for the visit.

On October 6, 2021, it was alleged that staff restrained resident, around a year before the allegation was made. The Department’s investigation consisted of review of facility records, and interviews of facility staff and outside sources.

Resident 1 (R1) reported to an outside source that they had been restrained while living at the facility. R1 could not recall when this incident occurred, nor by whom. R1 indicated that they had been restrained by their arms and that their arms had been twisted. At the time of reporting, R1 was diagnosed with dementia.

[Continued on LIC9099-C, Page 1 of 2]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Esther Miller	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

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-20221006140915

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: 06/15/2023

NARRATIVE

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[Continued from LIC9099, Page 2 of 2]

An outside source that visited R1 regularly stated that they never observed any indication of abuse, such as bruising or redness on R1. R1 also never disclosed to them that they had felt abused. Another outside source that regularly saw R1 on a professional basis also stated that they do not recall observing any indication of abuse, such as bruising or redness on R1. R1 also never disclosed to them that they had felt abused.

R1 left the facility around December 2021 due to quality-of-life issues, such as food. R1 moved into La Vida Real, 374603565, around that time. La Vida Real Administrator stated that, upon admission, there was no indication of bruising or redness on R1. R1 had never disclosed to any staff there that they had been restrained at Grossmont Gardens Senior Living. Administrator stated that R1 did not have violent or aggressive behavior while living at the facility. R1 was compliant and followed directions.

Facility records show extensive documentation into R1’s care. Nurse’s notes, that dated back to 2020, revealed documentation on R1’s confusion, blood pressure, medication deliveries, hospital visits, temperature, and falls. There was no indication that R1 ever reported being restrained, or mistreated by staff.

Based on the evidence obtained during the complaint investigation, the allegation that staff restrained resident is found to be UNSUBSTANTIATED, meaning that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Executive Director; a copy of this report and Licensee's Rights (LIC9058) were provided.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Esther Miller	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

LIC9099 (FAS) - (06/04)

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