<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603402
Report Date: 03/18/2026
Date Signed: 03/18/2026 03:21:25 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
03/06/2026 and conducted by Evaluator Ramon Serrano
COMPLAINT CONTROL NUMBER: 08-AS-20260306143759
FACILITY NAME:FREDERICKA MANORFACILITY NUMBER:
374603402
ADMINISTRATOR:BEN GESKEFACILITY TYPE:
740
ADDRESS:183 THIRD AVENUETELEPHONE:
(619) 205-4100
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:560CENSUS: 280DATE:
03/18/2026
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Corinna NortonTIME COMPLETED:
02:56 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of supervision resulted in resident self-neglect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegation. LPA met with Resident Services Director Corinna Norton and we discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of records review, interviews with facility staff and resident.

LPA reviewed R1’s facility records, which show R1 has hereditary motor and sensory neuropathy and alcoholic liver disease. According to their care plan dated 2/17/26, R1 is fully oriented, participates in activities, and has supportive family and community connections. The care plan states they are independent in all daily living tasks including bathing, grooming, dressing, toileting, eating, and mobility. They use a walker or cane but require no physical assistance. They self manage their own medications, do not need wellness checks, do not receive outside provider services, and have no identified special needs.




Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026
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-20260306143759
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: FREDERICKA MANOR
FACILITY NUMBER: 374603402
VISIT DATE: 03/18/2026
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
Facility charting documented several incidents involving R1’s alcohol use, falls, and smoking indoors. On 2/17/26, a med tech checked on R1, who denied falling but smelled strongly of liquor. Later that day, the med tech found R1 sitting on the floor by the toilet; R1 stated their legs gave out and they intentionally sat down. Staff also found an empty liquor bottle next to R1’s recliner and a lit cigar in the room. On 2/18/26, staff found R1 smoking a cigar in their room, reminded them of the no smoking policy, and offered to escort them to the patio, which R1 refused. On 2/20/26 at 1:36 a.m., R1 paged staff and was found stuck between the toilet. They smelled of alcohol, and staff called 911 for hospital transport.

Further documented incidents occurred on 3/3/26, 3/4/26, and 3/5/26. On 3/3/26, during dinner delivery, R1 was smoking and drinking liquor, prompting staff to notify security and the campus nurse. On 3/4/26 at 11:10 p.m., R1 paged staff and was found sitting on their living room floor, denying a fall. Earlier that morning, staff noticed cigar smoke in the hallway and notified security. On 3/5/26, R1 paged staff again and was found on the floor near their bed, stating they drank four ounces of vodka and could not recall if they hit their head. Staff called 911 for transport. Incident reports submitted to CCL reflect similar events on 10/28/25, 3/5/26, and 3/13/26, where R1 was found on the floor, smelled of alcohol, and was transported to the hospital.

LPA interviewed R1 in their room. LPA observed multiple tobacco pipes, several ashtrays, loose tobacco scattered on the floor, an unopened bottle of beer, and a strong odor of smoke. R1 stated they are being evicted due to smoking violations. R1 told LPA that staff are “wonderful,” check on them frequently, and help whenever they ask. R1 also stated they have had their medical condition since birth and that it contributes to their tendency to fall.


LPA interviewed several staff who assist R1. Staff 1, who oversees R1’s floor, stated they regularly offer R1 help with bathing, laundry, and escorting, but R1 consistently refuses, saying they will do it on their own later. Staff 1 stated they check on R1 at least every two hours because they are aware R1 drinks and smokes in their room. Staff 2 stated they work with R1 daily and that R1 smokes in their room one to two times a day, drinks liquor every day, and becomes intoxicated roughly once every two weeks. Staff 2 stated they check on R1 six to seven times a day to ensure they are safe. Staff 3 reported R1 is polite with them and often compliments them. Staff 3 also confirmed R1 regularly drinks and smokes in their room and stated they check on R1 about five times per shift due to R1 declining offered services. All staff interviewed stated that R1 consistently refuses assistance but that staff continue offering support and frequently monitor R1.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20260306143759
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: FREDERICKA MANOR
FACILITY NUMBER: 374603402
VISIT DATE: 03/18/2026
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
The Resident Services Director stated the facility has been working closely with R1 and their family for an extended period in an effort to provide the support R1 needs. They stated staff have offered R1 medication management, shower assistance, weekly housekeeping, laundry services, and escorting to the patio smoking area. R1 repeatedly declines these services, including refusing housekeeping that is included in their contract. The director stated the building has a strict no open flames policy, but R1 continues to smoke indoors, leaving ashes scattered throughout the unit. They also stated that R1 openly identifies as an alcoholic and has experienced multiple falls related to alcohol use. The director expressed concern that R1 could fall asleep or pass out while smoking, creating a fire hazard. Due to ongoing safety violations and repeated refusal to comply with the no smoking policy, the director stated R1 was issued a 30 day notice to vacate on 3/3/26, with a required move out date of 4/2/26.

Based on interviews, documentation, and observations, there is insufficient evidence showing the facility failed to supervise R1. R1 is assessed as fully independent, repeatedly refuses services, and continues unsafe behaviors due to personal choice rather than lack of staff involvement. Staff monitor R1 far more frequently than required, respond promptly to call pendant activations, redirect when possible, notify security, and call 911 when necessary. The incidents appear related to R1’s medical condition and their alcohol and tobacco use rather than any lack of supervision.

Based upon the foregoing, the above listed allegation is unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegation is unsubstantiated.

An exit interview was conducted with Corinna Norton. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Corinna Norton whose signature below verifies receipt of these rights.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3