374604232-1-9-2023-08-AS-DPOL-CNLVYC-20230131155056

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604232
Report Date: 01/09/2023
Date Signed: 01/09/2023 11:44:31 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
01/03/2023 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230103150505

FACILITY NAME:	REMINGTON CLUB II		FACILITY NUMBER:	374604232
ADMINISTRATOR:	TERRI BOSTIAN		FACILITY TYPE:	740
ADDRESS:	16922 HIERBA DRIVE		TELEPHONE:	(858) 673-6333
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92128
CAPACITY:	140	CENSUS: 54	DATE:	01/09/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Terri Bostian, Director, and Raquel Mathews, Licensed Vocational Nurse		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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- Facility did not provide resident(s) with three meals per day.
- Facility was in disrepair.
- Insufficient staff to meet the needs of resident(s).
- Non-operational call pendant.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility LPA investigated and delivered findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Madison Eccker, Receptionist. LPA stated the purpose of the visit and reviewed the findings of the complaint with Terri Bostian, Director, and Raquel Mathews, Licensed Vocational Nurse (LVN).

The Department’s investigation consisted of interviews with staff and an outside source, records reviewed of relevant documents pertinent to this investigation, and LPA observations of the facility grounds. On January 3, 2023, it was alleged that facility did not provide resident(s) with three meals per day; facility was in disrepair; insufficient staff to meet the needs of the resident(s); and non-operational call pendant.

Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff and an outside source interviews, and records reviewed, 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. The allegations were not pertinent to this licensed facility. The Department will be cross reporting this complaint to the appropriate agency for follow-up.

The report was discussed, and an exit interview was conducted with Terri Bostian, Director. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) was provided to Director Bostian at the conclusion of the visit. The signature below confirms the receipt of these documents.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

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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