374604232-5-15-2023-08-AS-DPOL-CSBVAC-20230530161544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604232
Report Date: 05/15/2023
Date Signed: 05/15/2023 10:32:01 AM

Substantiated

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
05/09/2023 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230509091651

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: 61	DATE:	05/15/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Terri Bostian, Assistant Executive Director		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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- Facility license number is not revealed in all public advertisements.

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 allegation. LPA identified herself and was granted entry by Amatourahm “Alma” Bileh, Receptionist. LPA stated the purpose of the visit and reviewed the findings of the complaint with Assistant Executive Director, Terri Bostian.

The Department’s investigation consisted of an interview with an outside source and LPA’s review of the Facility’s online website. On May 9, 2023, it was alleged that the Facility did not have their license number located on their website for their assisted living section of the facility. On Friday, May 12, 2023, LPA searched through the Facility’s entire website, including the assisted living sections of the site, in search of their license number provided by the Department. LPA was unsuccessful with the search for the Facility’s license number on their website. On Monday, May 15, 2023, LPA conducted a visit to the facility and delivered findings.

Substantiated

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: 05/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023

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-20230509091651

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: REMINGTON CLUB II	FACILITY NUMBER: 374604232
	VISIT DATE: 05/15/2023

NARRATIVE

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Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during an outside source interview and LPA observations of the Facility’s website, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099-D.

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

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20230509091651

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: REMINGTON CLUB II	FACILITY NUMBER: 374604232
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/15/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/31/2023 Section Cited CCR 87206(a)	1 2 3 4 5 6 7	87206 (a) Advertisements and License Number In accordance with Health and Safety Code Sections 1569.68 and 1569.681, licensees shall reveal each facility license number in all public advertisements, including Internet, or correspondence… this requirement was not met as evidence by:	1 2 3 4 5 6 7	The facility will be including their license number to their online website by POC due date, 05/31/2023. Assistant Deputy Director will inform LPA via email once their website has been adjusted to include their license number.
	8 9 10 11 12 13 14	Based on an interview and LPA observations of the Facility’s website, the facility did not provide a facility number to the community on their advertisements. This posed a potential personal rights risk to 61 of 61 (R1) residents in care.	8 9 10 11 12 13 14
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023

LIC9099 (FAS) - (06/04)

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