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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603884
Report Date: 06/19/2025
Date Signed: 06/19/2025 03:06:07 PM

Substantiated


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
06/12/2025 and conducted by Evaluator Arian Golbakhsh
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250612111814
FACILITY NAME:RIGHT CHOICE SENIOR LIVING CLAIREMONTFACILITY NUMBER:
374603884
ADMINISTRATOR:TODD BROOKSFACILITY TYPE:
740
ADDRESS:4929 MOUNT LONGSTELEPHONE:
(619) 246-2003
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:6CENSUS: 6DATE:
06/19/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Todd Brooks and Caregiver Christine ColemanTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Staff did not ensure correct medications were dispensed as prescribed to resident in care
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced visit to open a complaint investigation and delivered findings regarding the above mentioned allegations. LPA was welcomed by, identified themselves to, and discussed the purpose of their visit to Administrator Todd Brooks. Note, LPA did step out for lunch from 11:15-12:15.

On 06/12/2025, the Department received a complaint where it was alleged that a resident at the facility identified as (R1) was given incorrect medications. The Department’s investigation consisted of an unannounced facility visit, records review, as well as interviews with staff and residents.

[Continued on LIC 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
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-20250612111814
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: RIGHT CHOICE SENIOR LIVING CLAIREMONT
FACILITY NUMBER: 374603884
VISIT DATE: 06/19/2025
NARRATIVE
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[Continued from LIC 9099]

Interviews with staff and file review corroborate that R1 was given incorrect medications by a staff member (identified as S1), which according to staff interviews, belonged to another resident identified as R2. Interviews with residents did not reveal additional details regarding the incident. Outside source medical records corroborate the timeline of the incident and revealed no changes to R1's medication list post incident.

Based on LPA's review and outside source records, along with interviews with staff and residents, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A deficiency was cited per California Code of Regulations, Title 22, Division 6 on the attached 9099D. An exit interview was conducted with Administrator Ancho to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20250612111814
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: RIGHT CHOICE SENIOR LIVING CLAIREMONT
FACILITY NUMBER: 374603884
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2025
Section Cited
CCR
87465(a)(4)
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87465(a)(4): The licensee shall assist residents with self-administered medications as needed.

This requirement is not met as evidenced by:
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Licensee will submit proof of review/retraining of medication administration procedure with S1 to LPA by the POC due date.
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Based on file review and interviews, the Licensee did not ensure proper medication administration procedures, resulting in a medication error, posing a potential health and safety risk to 1 out of 6 residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
06/12/2025 and conducted by Evaluator Arian Golbakhsh
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250612111814

FACILITY NAME:RIGHT CHOICE SENIOR LIVING CLAIREMONTFACILITY NUMBER:
374603884
ADMINISTRATOR:TODD BROOKSFACILITY TYPE:
740
ADDRESS:4929 MOUNT LONGSTELEPHONE:
(619) 246-2003
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:6CENSUS: 6DATE:
06/19/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Todd Brooks and Caregiver Christine ColemanTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure reporting requirements were followed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced visit to open a complaint investigation and delivered findings regarding the above mentioned allegations. LPA was welcomed by, identified themselves to, and discussed the purpose of their visit to Administrator Todd Brooks. Note, LPA did step out for lunch from 11:15-12:15.

On 06/12/2025, the Department received a complaint where it was alleged that the facility did not notify a resident's (identified as R1) Responsible Party following an incident regarding R1. The Department’s investigation consisted of an unannounced facility visit, records review, and interviews with staff, residents, and outside sources.

[Continued on LIC 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20250612111814
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: RIGHT CHOICE SENIOR LIVING CLAIREMONT
FACILITY NUMBER: 374603884
VISIT DATE: 06/19/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
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12
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15
16
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[Continued from LIC 9099]

Interviews with staff and file review reveal that the facility did follow reporting requirements by submitting an Incident Report to the Department within the required time-frame. Additionally, it was revealed through staff interviews and review of facility records that R1 does not have a designated Responsible Party.

Based on interviews and records review, while the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred – therefore the allegations have been determined to be UNSUBSTANTIATED. An exit interview was conducted with Administrator Brooks to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5