374604675-4-15-2025-08-AS-RCLK-DG92QP-20250430173615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604675
Report Date: 04/15/2025
Date Signed: 04/15/2025 08:16:54 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
04/07/2025 and conducted by Evaluator Natasha Persaud

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20250407152901

FACILITY NAME:	GROSSMONT GARDENS SENIOR LIVING		FACILITY NUMBER:	374604675
ADMINISTRATOR:	JONES, REGINALD		FACILITY TYPE:	740
ADDRESS:	5480 MARENGO AVE		TELEPHONE:	(619) 463-0281
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	425	CENSUS: 372	DATE:	04/15/2025
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Health Services Director, Stacy Tinoco		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Staff unlawfully evicted a resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit regarding the allegation mentioned above. LPA met with Health Services Director, Stacy Tinoco.

During the investigation, records were reviewed and interviews conducted with staff and outside sources. It was alleged staff unlawfully evicted Resident #1 (R1). It was reported R1 went to the hospital and was ready for discharge, but the facility staff did not allow R1 to return. R1’s Physician’s Report dated 09/16/24 indicated R1 had a diagnosis of a Major Neurocognitive Disorder and required assistance with bathing, dressing/grooming, toileting, and medication management. R1’s Service Plan dated 02/20/25 reflected R1 frequently resists care. R1 went to the hospital on 04/02/25 via ambulance from the facility due to increased agitation and several cases of R1 hurting caregivers. A review of facility records indicated the Executive Director (ED) communicated with R1’s responsible party regarding R1 requiring a higher level of care. Grossmont Gardens Assisted Living Observations documentation dated 04/03/25 indicated the ED spoke with R1’s responsible party regarding R1’s aggressive behaviors. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Robyn Clark	TELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

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-20250407152901

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: GROSSMONT GARDENS SENIOR LIVING	FACILITY NUMBER: 374604675
	VISIT DATE: 04/15/2025

NARRATIVE

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It also showed the responsible party agreed R1 should not return and needed a higher level of care to get medications managed. Per ED’s documentation, R1’s responsible party would be informing the hospital and medical provider not to discharge R1 back to the facility. Grossmont Gardens Assisted Living Observations documentation dated 04/04/25 indicated the ED spoke with R1’s responsible party and the responsible party stated they would be at the facility over the weekend to move R1’s items out. It also stated R1 will not be returning and will be going to a higher level of care. The documentation dated 04/05/25 stated the hospital called and was attempting to set up transportation back to the facility. The facility nurse advised the hospital that R1 was not returning per R1’s responsible party and the responsible party wanted R1 to go to a higher level of care facility. The facility’s documentation stated the hospital staff will contact the responsible party. The facility nurse’s interview revealed they did not deny R1’s return to the facility but was following the instructions of R1’s responsible party. The hospital staff’s interview confirmed the facility nurse did not deny the return of R1. However, conflicting information was provided and needed to be confirmed. The facility’s documentation dated 04/06/25 indicated R1’s responsible party was provided all of R1’s medications, as they were no longer going to reside at the facility. There was some miscommunication between the facility, R1’s responsible party, and the hospital. It was agreed upon by the ED and R1’s responsible party that R1 required a higher level of care but a date was not determined for relocation. However, the documentation identified 04/03/25, which was prior to the discharge date, that R1 would not be returning to the facility, per R1’s responsible party. Per facility staff, R1 was not evicted or issued a notice of eviction, the facility acted upon the discussion had with R1’s responsible party and supplied that information to the hospital staff.

During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Health Services Director, Stacy Tinoco whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]

SUPERVISOR'S NAME: Robyn Clark	TELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

LIC9099 (FAS) - (06/04)

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