374604271-11-16-2021-08-AS-SJAB-CA7TXE-20211230140702

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604271
Report Date: 11/15/2021
Date Signed: 11/16/2021 09:54:48 AM

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
09/21/2021 and conducted by Evaluator Kristina Ryan

COMPLAINT CONTROL NUMBER: 08-AS-20210921122241

FACILITY NAME:	SANTEE ELDERLY CARE		FACILITY NUMBER:	374604271
ADMINISTRATOR:	DERMODY, THOMAS		FACILITY TYPE:	740
ADDRESS:	9069 INVERNESS RD		TELEPHONE:	(619) 929-9939
CITY:	SANTEE	STATE: CA	ZIP CODE:	92071
CAPACITY:	6	CENSUS: 6	DATE:	11/15/2021
		UNANNOUNCED	TIME BEGAN:	02:02 PM
MET WITH:	Licensee, Thomas Dermody		TIME COMPLETED:	03:02 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Unlawful Eviction.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Kristina Ryan, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA was allowed entry into the facility after identifying herself and stating the purpose of the visit. LPA met with Licensee, Thomas Dermody.

The Department’s investigation consisted of a review of facility administrative and care records. It also involved interviews with facility staff, and outside sources.

CONTINUED ON LIC 9099-C, 1 of 2]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina Ryan	TELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021

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-20210921122241

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: SANTEE ELDERLY CARE	FACILITY NUMBER: 374604271
	VISIT DATE: 11/15/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The Department received a complaint on September 21, 2021 alleging that the facility unlawfully evicted Resident 1 (R1). Interviews with facility staff and R1’s responsible party, revealed that (R1) was a resident at the facility and their legally responsible person signed an admission agreement on September 29, 2018. Interviews with staff and outside agencies revealed that the responsible party of R1 had been concerned about the cost of living for R1 at the facility and had been looking into other care facilities as a result. On September 20, 2021, R1’s responsible party contacted facility staff and told them that R1 would be moving. Text messages from R1’s responsible party to facility staff state that R1 was being moved on September 20. 2021. R1 was picked up from the facility by an unknown party on September 20, 2021. After leaving the facility, R1 was brought to a local hospital by an unknown individual and then transferred to a Skilled Nursing Facility. Facility staff and R1’s responsible party deny any staff involvement in transporting R1 to the hospital.

Interviews with R1’s responsible party, reveal that they chose for R1 to be moved and did not want R1 returning to Santee Elderly Care. R1’s responsible party stated that on September 20, 2021 a family friend brought R1 to the hospital for an unspecified change of condition. Interviews with outside sources dispute that there was a change in condition and there is no documentation of R1 sustaining any injuries. R1’s responsible party stated that R1 was moved due to needing a higher level of care. A review of facility records and interviews with staff do not indicate that R1 had needs that could not be met at the facility. R1’s responsible party was unable to provide further clarification about why R1 was moved. However, they stated that the move was not due to any action from the facility and facility management did not issue an eviction.

The Department has investigated the complaint alleging an Unlawful Eviction. There is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with the Licensee and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to the licensee via electronic mail. An electronic read receipt confirmation was requested to be sent by the licensee upon receipt of the documents.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina Ryan	TELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2