374604675-1-5-2024-08-AS-LTEZ-CZCUYR-20240110150022

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604675
Report Date: 01/05/2024
Date Signed: 01/05/2024 05:00:50 PM

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
12/29/2023 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20231229124840

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: 314	DATE:	01/05/2024
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Executive Director, Reginald Jones		TIME COMPLETED:	02:00 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), Natasha Persaud conducted a complaint investigation visit regarding the above mentioned allegation. LPA met with Executive Director, Reginald Jones.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, and outside sources. It was alleged the facility unlawfully evicted Resident #1 (R1). On 12/27/23, R1 fell and was transported to the hospital. The hospital discharged R1 on 12/27/23 and sent R1 back to the facility via transport. When R1 arrived back at the facility the same day, the facility denied their return. The facility told transport they would not be accepting R1 back and told transport to take R1 back to the hospital, which they did. Outside source interviews confirmed the Executive Director declined the return again on 12/28/23, and R1 remained at the hospital. Continued on an LIC 9099C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

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 3

Control Number 08-AS-20231229124840

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: GROSSMONT GARDENS SENIOR LIVING	FACILITY NUMBER: 374604675
	VISIT DATE: 01/05/2024

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

On 12/29/23, the Executive Director was contacted again to accept R1 back to the facility, the Executive Director declined again. Further interviews revealed on 12/31/23, the Executive Director declined R1’s return again. On 01/03/24, LPA intervened and spoke with the Executive Director advising him they must take the resident back as that is their home. The Executive Director explained had already spoken with the hospital and was accepting R1 back into the facility. The Executive Director agreed to allow R1 to return. R1 returned to the facility on 01/04/24. The Executive Director, explained the reason R1 was not allowed to return was because they were awaiting a care plan from the hospital and wanted to appropriately assess R1. The Executive Director also stated part of the reason for not allowing R1 to return was due to a behavioral disturbance caused by R1.

Based on interviews, preponderance of evidence standard has been met, therefore the above allegation was found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Executive Director, Reginald Jones whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20231229124840

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: GROSSMONT GARDENS SENIOR LIVING	FACILITY NUMBER: 374604675
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/05/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/02/2024 Section Cited CCR 87224(a)	1 2 3 4 5 6 7	Eviction Procedures. The licensee may evict a resident for one or more of the reasons...Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5). This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Executive Director allowed R1 to return to the facility. Executive Director agreed to attend training on Eviction Procedures and send proof of training by POC due date.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not issue a written notice of eviction for 1 out of 314 [R1] residents, which posed a potential personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3