374603509-3-10-2025-08-AS-SJAB-DF7NBC-20250328101851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603509
Report Date: 03/10/2025
Date Signed: 03/10/2025 06:29:17 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
05/31/2024 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20240531124436

FACILITY NAME:	WESTMONT AT SAN MIGUEL RANCH		FACILITY NUMBER:	374603509
ADMINISTRATOR:	ZEPEDA, JESSICA		FACILITY TYPE:	740
ADDRESS:	2325 PROCTOR VALLEY RD		TELEPHONE:	(619) 271-4385
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91914
CAPACITY:	105	CENSUS: 89	DATE:	03/10/2025
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Business Office Director, Ellen Arguello		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Resident charged for services not rendered

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Business Office Director, Ellen Arguello.

The Department investigated the above-listed complaint allegation. The investigation consisted of a tour of the facility, multiple interviews with staff and residents, and a detailed records review, including medical records, health and service evaluation/assessment reports, service care plans, invoice billing statements and other relevant evidence pertinent to this investigation.

On May 31, 2024, Community Care Licensing (CCL) received a complaint alleging that Resident (R1) was charged for services not rendered. [an LIC 811 Confidential Names List was provided to staff to identify the Resident].
(Continue at LIC9099)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

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 5

Control Number 08-AS-20240531124436

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: WESTMONT AT SAN MIGUEL RANCH	FACILITY NUMBER: 374603509
	VISIT DATE: 03/10/2025

NARRATIVE

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(Continue from LIC9099)

It was specifically alleged that R1 was charged for a level of care increase on December 20, 2023, despite no documented change in R1’s medical condition per R1’s attending physician. However, a detailed review conducted on June 4, 2024, of R1’s medical records, health and service evaluations, and service care plans from May 16, 2022, through June 1, 2024, indicated a significant decline in R1’s medical condition (see details of the change in R1’s condition below).

Additionally, a comprehensive review of R1’s account summaries and billing statements for the period in question (October 24, 2023, through June 1, 2024) confirmed that the charges accurately reflected the level of care provided by facility staff (see details of the billing statements below).

Lastly, interviews with staff and with external sources did not corroborate the claim that R1’s level of care remained unchanged.

Details of R1’s change in condition:

The physician's report at the time of admission, dated July 6, 2022, indicated that R1 was diagnosed with Alzheimer’s disease, secondary diagnosis dementia with behavioral disturbance, hypertension, (high blood pressure), hyperlipidemia (abnormally high levels of cholesterol, triglycerides or other lipids in the blood), DYNA (group of serious and complex conditions that are caused by malfunction of the autonomic nervous system), CHF (congestive heart failure), COPD (chronic obstructive pulmonary disease), A-fib atrial fibrillation (irregular and rapid beating of the ventricles. On May 16, 2022, when R1 moved into the facility under the Memory Care level 2 service care plan. R1's responsible party reviewed and signed the service care plan on July 12, 2022.

On September 27, 2022, R1’s assessment indicated a change in condition and an increase in level of care due to increased checks to 4x additional checks per shift. The prior assessment showed that R1 did not need additional checks. The service care plan was signed by R1’s responsible party on October 1, 2022.

(Continue at LIC9099C)

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 08-AS-20240531124436

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: WESTMONT AT SAN MIGUEL RANCH	FACILITY NUMBER: 374603509
	VISIT DATE: 03/10/2025

NARRATIVE

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(Continue from LIC9099C)

On March 24, 2023, R1’s assessment indicated a significant change in condition. R1's level of care increased to MC- level 3. The main contributing factor for the increase in the level of care was due to incontinence care increased to maximum assistance. R1’s prior assessment showed that R1 was independent in this category. In addition, R1 required daily assistance with special medications (creams and hydrocortisone cream). In the earlier assessment, R1 did not require any special medications. The service care plan was reviewed and signed by R1’s responsible party on March 24, 2023.

On June 8, 2023, R1’s assessment showed a significant change in condition. R1's level of care increased to MC - Level 5, R1 required a higher level of care due to several medical condition changes. R1 required maximum assistance with special care needs, and R1 required daily assistance with oxygen use. The care team assisted in meeting R1's care needs with oxygen use to improve R1's quality of life. In addition, R1's change in condition required moderate assistance to provide frequent help due to disorientation, memory loss, difficulty completing tasks, increased episodes of memory, and/or cognitive impairment. Moderate assistance with wandering to other residents' rooms and R1 attempting to leave the building. R1 required daily intervention due to disruptive, aggressive, or socially inappropriate behavior. R1 care team was required to intervene due to R1's uncooperative and resistance to care, R1 had significantly increased levels of depression, anxiety, and/or mood disorder. The assessment and service care plan were reviewed with R1’s responsible party on June 8, 2023.

On December 20, 2023, R1’s assessment showed a significant change in condition. R1's level of care increased to MC Level 7 (highest level of care). R1 required maximum assistance in all areas of care to meet R1’s needs. R1’s level of care increased with transfers from 0 to 60 maximum assistance due to requiring 2-person assistance due to R1 becoming non-weight-bearing. Assistance with mobility increased from 0 to 65 maximum assistance requiring 2-person assistance with observation and fall management. R1’s meals and nutrition needs increased from 0 to 30 maximum assistance requiring special cutting/preparing food (mechanically soft) and/or prompting throughout the meal. R1’s responsible party reviewed and signed the assessment and service plan on April 13, 2024.

(Continue at LIC9099C)

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 08-AS-20240531124436

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: WESTMONT AT SAN MIGUEL RANCH	FACILITY NUMBER: 374603509
	VISIT DATE: 03/10/2025

NARRATIVE

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(Continue from LIC9099C)
On 2/16/2025 LPA Garcia-Centeno reviewed the invoice billings from October 24, 2023, to June 2024. The allegation was that the resident was charged for services not rendered for this period.

Statement period	Payment due date	MC Level	Rent	MC Charge	Net Due
10/24/23 - 11/22/23	12/1/2023	MC Level 3	$4,476.15	$2,000	$2,000
11/22/23 - 12/22/23	01/01/24	MC Level 3 prorated 12/20 - 12/31/23 (credit)	$ 4,4745	$2,000 - $774.19	$1,225.81
		MC Level 7 prorated 12/20 - 12/31/23 $3,900		$$3,900- $2,390	$$1,509.68
					$2,735.49
12/22/2023 - 1/22/24	02/01/24	Care - MC 7 2/1/24 to 2/29/24	$4,745	$3,900	$3,900
1/22/24 - 2/21/24	3/1/24	Care - MC 7 3/1/24 to 3/31/24	$4,745	$3,900	$3,900
2/21/24 - 3/18/24	4/1/24	MC Level 7 4/1/24 to4/30/24	$4,745	$3,500
		Care - MC 4/1/24 to 4/30/24		$400	$3,900
3/18/24 - 4/23/24	5/1/24	MC Level 7 5/1/24 to 5/31/24	$4,745	$3,500
		Care - MC 5/1/24 to 5/31/24		$400	$3,900
4/23/24 - 5/21/24	6/1/2024	MC Level 7 6/1/24 to 6/30/24	$4,745	$3,500
		Care - MC 6/1/24 to 6/30/24		$400	$3,900

(Continue to LIC9099C)

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 08-AS-20240531124436

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: WESTMONT AT SAN MIGUEL RANCH	FACILITY NUMBER: 374603509
	VISIT DATE: 03/10/2025

NARRATIVE

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(Continue from LIC9099C)

Based on the review of R1's billing statements and account summaries from October 24, 2023, through May 21, 2024, R1 was billed correctly according to R1's level of care as indicated on service care plans.

Based on observations, interviews with key staff and outside sources, and a review of pertinent records there was insufficient evidence found to support the allegation that R1 was charged for services not rendered. Due to a lack of evidence, the allegation is deemed to be unsubstantiated. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence that the alleged violation occurred.

An exit interview was conducted with Business Office Director, Ellen Arguello to whom a copy of this report, LIC 811, and Licensee Appeal Rights (9058 03/22) were provided at the conclusion of the visit.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

LIC9099 (FAS) - (06/04)

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