374604060-4-13-2022-08-AS-IESA-CDY82K-20220429220800

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604060
Report Date: 04/12/2022
Date Signed: 04/13/2022 05:43:28 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
01/19/2022 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20220119084723

FACILITY NAME:	GROSSMONT GARDENS SENIOR LIVING		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: 179	DATE:	04/12/2022
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Associate Executive Director Lane Hermosillo		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Licensee did not check visitors' COVID-19 vaccination status.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by and identified himself to receptionist Rosalinda Aquino. LPA then met with and discussed the purpose of the visit with Associate Executive Director Lane Hermosillo.

It was alleged that during January 2022, licensee’s staff did not ask Visitor #1 (V1) to present proof they were vaccinated against COVID-19, as was required by CDSS Provider Information Notices (PINs). The Department’s investigation consisted of touring the facility, interviewing staff, auditing the visitor sign in process over multiple days, and reviewing licensee’s LIC808 COVID-19 Mitigation Plan and visitor sign-in logs.

PIN 21-40-ASC was in force during the first part of January 2022. It was superseded on January 18th, 2022 by PIN 22-04-ASC. Both CDSS documents instructed Licensee to require non-essential visitors to present proof that they were “fully vaccinated” against COVID-19 before starting an indoor visit with a resident. [CONTINUED ON LIC 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

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-20220119084723

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: 04/12/2022

NARRATIVE

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[CONTINUED FROM LIC 9099]

(LPA also discussed with Licensee the vaccination verification requirement for indoor visitors via a December 29, 2021 E-mail and phone call, proving constructive notice.)

LPA made unannounced visits to the facility on January 3, 2022, January 10, 2022, January 27, 2022, and March 21, 2022, respectively. During 4 of 4 visits, the front-desk lobby area was manned by 1 or 2 facility staff. Upon arrival, they ensured LPA wore a surgical mask, measured his body temperature with a touchless thermometer, required him to answer COVID-19 screening questions, and ensured he used hand sanitizer. They also asked LPA to present his COVID-19 Proof of Vaccination card, even though he met criteria for being an essential/exempt visitor.

During the January 27, 2022 visit, LPA continuously observed two shifts of receptionists for 30 minutes each, from a distance and unbeknownst to them. Every family visitor who entered during the observation windows was correctly vetted and showed proof of vaccination in addition to a negative test result. (Those who did not already have such a result were assisted by staff with taking a rapid antigen test and waiting for the result). During the March 21, 2022 visit, LPA observed the receptionist and their assistant for 30 minutes, again from a distance and unbeknownst to them. Every family visitor who entered on this date was correctly vetted and showed proof of vaccination. (Negative test results were no longer required for fully vaccinated visitors by this latter date).

Interviews with 4 of 4 front line lobby staff, plus 2 of 2 managers, and the facility’s infection control preventionist, demonstrated it was common knowledge that non-essential indoor visitors must be asked to present proof of vaccination. This was corroborated by the facility’s Visitor Sign-In Log, which had a printed boilerplate notice stating proof of vaccination was required for indoor visits. (This Sign-In Log had also long been in use, as evidenced by multiple filing boxes filled with completed logs, which LPA located inside a facility storage closet.)

Based on records and interviews, a preponderance of evidence does not exist to support the allegation that Licensee did not check visitors’ COVID-19 vaccination status according to CDSS requirements. The allegation is therefore unsubstantiated. An exit interview was conducted with Hermosillo, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

LIC9099 (FAS) - (06/04)

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