374604318-5-31-2024-08-AS-LTEZ-D5T2FW-20240531172214

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604318
Report Date: 05/31/2024
Date Signed: 05/31/2024 09:12:18 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
05/09/2022 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20220509093246

FACILITY NAME:	WESTMONT OF ENCINITAS		FACILITY NUMBER:	374604318
ADMINISTRATOR:	BLOOM, CHARLES		FACILITY TYPE:	740
ADDRESS:	1920 SOUTH EL CAMINO REAL		TELEPHONE:	(858) 729-6720
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	101	CENSUS: 80	DATE:	05/31/2024
		UNANNOUNCED	TIME BEGAN:	08:51 AM
MET WITH:	Operation Specialist Benjie Doctolero		TIME COMPLETED:	09:25 AM

ALLEGATION(S):

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Resident was sexually assaulted while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced a follow up complaint
investigation visit and delivered complaint findings. The LPA introduced himself and disclosed the
purpose of the visit to Operation Specialist Benjie Doctolero.

Throughout the investigation, the Department secured records and conducted interviews with external
and internal sources, including staff and residents.

It was alleged a resident was sexually assaulted while in care by Staff #1 (S1). (See 811 – Confidential Names Form).

A review of R1's LIC 602 (Physician's report), and Preplacement Appraisal, collected
from the facility, revealed R1 was considered ambulatory, in good health, diabetic, able to
communicate, but may be confused and disoriented. (See LIC 9099C for continuation of report.)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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-20220509093246

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: WESTMONT OF ENCINITAS	FACILITY NUMBER: 374604318
	VISIT DATE: 05/31/2024

NARRATIVE

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The Department interviewed facility management. According to facility management, R1 provided inconsistent statements, changing the gender of the caregiver, and inconsistencies on when the abuse took place. R1 sometimes stated it occurred during medication application, while being assisted with changing, or that it had occurred in the shower during a bath. R1 was not able to provide a specific date or time as to when the abuse occurred. The facility was only aware of the Sheriff’s investigation, as an officer came out to the facility after R1 was Hospitalized for an unrelated medical issue on 5/8/2022. Facility management was not aware of any other similar report from R1. Facility management believed R1 may have reported abuse to facilitate R1’s transfer out of the facility.

An incident report obtained from the San Diego County Sheriff’s Office reported the following
information. On 5/9/2022, a Sheriff’s officer interviewed R1, who reported the alleged incident had occurred approximately six months prior. R1 did not recall the exact date or time, only that the incident had occurred in the morning and that S1 had raped R1. During the interview, R1 had difficulty staying focused, would veer off topic, and would become agitated with unrelated topics. There were no witnesses, no evidence collected, and due to the time elapsed since the incident, no Sexual Assault Response Team (SART) exam was conducted. R1 also told the responding officer the incident had already been reported to the Sheriff's Department, but that officer was unable to complete the report. The responding officer’s search for the report did not produce any previous reports from R1. The officer attempted contacts with the reporting party, and with S1, but all were unsuccessful.

An interview with S1, conducted by the Department, revealed S1 assisted R1 with showers, medication management, and partial toileting needs. S1 was aware R1 had made allegations of being touched inappropriately by S1, but S1 denied any sexual interaction from S1, nor from other staff at the facility.

Interviews with residents, and current and former staff did not reveal any concerns regarding abuse at the facility. These sources did not witness any type of abuse at the facility.

Based on the evidence obtained, there was not enough evidence to prove the alleged violation
occurred, therefore, the allegation was Unsubstantiated.An exit interview was conducted with Doctolero, to whom a copy of this report, LIC 811 Confidential names list, and Licensee/Appeals Rights (LIC 9058) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

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