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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601005
Report Date: 02/06/2025
Date Signed: 02/06/2025 10:42:33 AM

Unfounded


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
01/27/2025 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20250127091151
FACILITY NAME:VETERANS HOME CHULA VISTAFACILITY NUMBER:
374601005
ADMINISTRATOR:KATHRYN GABRIELFACILITY TYPE:
740
ADDRESS:700 EAST NAPLES COURTTELEPHONE:
(619) 205-1154
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:55CENSUS: 20DATE:
02/06/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Kathy GabrielTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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9
-Licensee neglect, contributing to resident’s skin breakdown.
-Licensee did not meet resident’s incontinence care need.
-Licensee did not provide responsible person with requested records.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced complaint visit to investigate the above allegations. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Kathy Gabriel.

The Complainant alleged that Licensee’s neglect contributed to Person #1 (P1’s) skin breakdown, that Licensee did not meet P1’s incontinence care need, and the Licensee did not provide requested records to P1’s responsible person. [See LIC811 Confidential Names List for a description of R1.] CCLD’s investigation involved an un unannounced facility tour/welfare check and a collateral visit. The Department also interviewed pertinent administrative records and interviewed relevant facility staff and outside sources.


[CONTINUED ON LIC 9099-C]
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
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-20250127091151
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: VETERANS HOME CHULA VISTA
FACILITY NUMBER: 374601005
VISIT DATE: 02/06/2025
NARRATIVE
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[CONTINUED FROM LIC 9099]

Records, interviews, and LPA observation unanimously showed: P1 was not a resident of the CCLD-licensed facility, either at present or during the timeframe of the complaint allegations.

Based on records and interviews, these three (3) allegations are Unfounded, meaning they are false, could not have happened, and/or are without a reasonable basis. We have therefore dismissed the allegations, and no deficiencies were cited.

An exit interview was conducted with the Gabriel, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2