374604675-10-17-2025-08-AS-HHUL-DN4VP3-20251104153605

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604675
Report Date: 10/17/2025
Date Signed: 10/17/2025 09:53:27 AM

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
01/02/2024 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 08-AS-20240102162224

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: 373	DATE:	10/17/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Reginald Jones, Administrator		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Questionable Death
Facility did not meet resident's hygiene needs

INVESTIGATION FINDINGS:

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On 10/17/2025 at 9:45AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger meet virtually via Teams to deliver findings for the above allegations. LPA explained the purpose of the visit with Administrator Reginald Jones.

During the course of investigation, the Department conducted interviews with staff, the residents’ family, and the reporting party. R1's medical records, Physicians report, Diet clarification order, health assessment, services plan, and nurses notes were collected

On the allegation: Questionable Death
Based on interviews and records review on 1/1/2024 R1 was observed to have missed breakfast and was found in his room on the floor by family around 11:00 am.
Continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240102162224

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: GROSSMONT GARDENS SENIOR LIVING	FACILITY NUMBER: 374604675
	VISIT DATE: 10/17/2025

NARRATIVE

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...Continued from LIC 9099

R1’s medical records state three different amounts of time of how long R1 may have been on the ground before being found by family. The first stated R1 was on the ground for an unknown period. The second stated R1 may have been on the ground for more than 24 hours and the third statement stated the R1 was likely on the ground for a couple of days. During the investigation, factual information was obtained that R1 was observed at the facility four times on 12/31/2023, by staff and R2, the last time being around 7:00 PM. During these times R1 did not exhibit any signs of distress or injury. R1 was independent and did not need any assistance with his Activities for Daily Living (ADLs). Although R1 had a call button in his room. There is no corroborating information to show the facility was negligent.

On the allegation: Facility did not meet resident's hygiene needs

Based on interviews and records review S1 said R1 did not keep a very clean apartment, he wore the same clothes for a few days in a row, and he did not always keep up with his hygiene. R1’s Needs and Service Plan indicated that R1 was Independent and was capable of R1’s own Grooming/Personal Hygiene. S2 said that's how R1 was, he didn't want assistance and didn't allow housekeeping to enter his room to be cleaned. R1 wore repeated outfits, but he was decent looking, he didn't have any stains or rips in his clothing. R1 did not have any hygiene odors, he just wore the same clothing, which made it seem like he wasn't clean. When interviewed R2 stated that R1 was clean and never had odors or poor hygiene

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided via email.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

LIC9099 (FAS) - (06/04)

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