374604545-4-11-2024-08-AS-SJAB-D4NUUZ-20240425155422

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604545
Report Date: 04/11/2024
Date Signed: 04/11/2024 07:12:46 PM

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
04/05/2024 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20240405151000

FACILITY NAME:	GARDENS AT ESCONDIDO		FACILITY NUMBER:	374604545
ADMINISTRATOR:	MCBRIDE, FERLINA		FACILITY TYPE:	740
ADDRESS:	1342 NORTH ESCONDIDO BLVD		TELEPHONE:	(760) 480-8155
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92026
CAPACITY:	101	CENSUS: 68	DATE:	04/11/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Executive Director Angela Scott-Kapiloff		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Licensee did not adhere to the admission agreement
Licensee did not assist resident(s) with transportation

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver the finding on the above mentioned complaint allegations. LPA Domingo identified herself and discussed the purpose of the visit with Executive Director Angela Scott-Kapiloff

During the investigation, LPA Domingo collected pertinent resident records as well as facility documentation and conducted interviews with staff, residents and outside sources.

It was alleged that the Licensee did not adhere to the admission agreement. The Reporting Party (RP) specified that the licensee did not provide basic cable and that the cable bill was not paid therefore the cable television was not working. LPA Domingo reviewed the entire admission agreement and basic cable television was no working. LPA Domingo reviewed the entire admission agreement and basic cable

(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

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-20240405151000

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: GARDENS AT ESCONDIDO	FACILITY NUMBER: 374604545
	VISIT DATE: 04/11/2024

NARRATIVE

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Continued from LIC9099)

television was paid by the facility, if the resident requested more channels or extended cable television, the cost would be billed directly to the resident with separate billing. Staff 3 (S3) (See LIC811 Confidential Names list), provided LPA with the last three months of paid invoices for the basic cable television service. There was no evidence of the bills not paid. LPA Domingo interviewed Resident 1 (R1) and R1 stated that there has not been any cable television problems that R1 can recall. LPA Domingo interviewed Resident 2 (R2) and R2 stated that the cable television has been working since the day R2 moved in which was one year ago. LPA Domingo interviewed Staff 1 (S1) regarding any knowledge of the cable service being discontinued and S1 stated that there has not been any cable service problems at the facility.

It was alleged that the Licensee did not assist residents with transportation. LPA interviewed S1 regarding the provided transportation for the residents and S1 stated that the facility transportation bus has been under repairs for the last 4 months and staff members will transport residents to appointments as needed. LPA Domingo requested S3 to provide documentation on the status of the repairs with the transportation vehicle and there are invoices dating being at the end of December 2023 of continued repairs with the transportation vehicle. The most recent repair receipt dated 03/28/24. R1 was interviewed regarding the transportation vehicle and medical appointments. R1 stated that staff provide transportation to appointments as needed and R1 has not been made aware of any other residents concerns regarding the transportation vehicle. R2 was interviewed and R2 was also not aware of any concerns regarding the transportation vehicle or medical appointments being missed because of the repairs being made with the vehicle.

Based on LPA's interviews with residents, staff, outside source interview, and records reviewed there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Executive Director Angela Scott-Kapiloff, to whom a copy of this report, and Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

LIC9099 (FAS) - (06/04)

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