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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604684
Report Date: 01/29/2025
Date Signed: 01/29/2025 11:57:46 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
12/30/2024 and conducted by Evaluator Amy Rodgers
COMPLAINT CONTROL NUMBER: 08-AS-20241230111305
FACILITY NAME:GROSSMONT GARDENS MEMORY CAREFACILITY NUMBER:
374604684
ADMINISTRATOR:SUZETTE JOHNSONFACILITY TYPE:
740
ADDRESS:4960 MILLS STREETTELEPHONE:
(619) 644-1100
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:64CENSUS: DATE:
01/29/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Executive Director Natalie Carlborg TIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Licensee did not provide sufficent staff to meet residents needs
Licensee did not maintain a clean facility
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Amy Rodgers conducted an unannounced visit to further investigate the complaint and to deliver findings regarding the above-mentioned allegations. LPA was welcomed by, identified herself to, and discussed the purpose of their visit with Executive Director Natalie Carlborg.

On 12/30/24 it was alleged that the licensee did not provide sufficient staff to meet residents needs and licensee did not maintain a clean facility. The Department’s investigation consisted of an unannounced facility visit, records review, and interviews with staff, residents, and outside sources.


(Continued on 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
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-20241230111305
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 MEMORY CARE
FACILITY NUMBER: 374604684
VISIT DATE: 01/29/2025
NARRATIVE
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(Continued form 9099)

Although the reported party stated they observed residents who needed a higher level of care, residents with incontinence needs not being met, and very low staffing; outside sources, resident interviews and residents’ family members stated they felt their needs were being met. Staff interviews indicated that there are enough staff to meet the needs of the residents. A review of the schedule for the entire month of November and December 2024 also revealed the facility was adequately staff. A facility tour did not corroborate the insufficient staffing, residents were observed being assisted by care staff as appropriate on three (3) separate visits.

Staff interviews also confirmed the practice of changing and toileting residents every two (2) hours. Records review as well as interviews with the licensee, staff, and medical personnel, were conducted and revealed that although some residents required more incontinence and toileting care, there wasn’t any documentation of concern for neglect, abuse, or non-accidental injuries were noted. A review of resident records that were assessed at a high level revealed residents were assisted by direct care staff as well as receiving assistance from outside sources, and no concerns were noted.

Reporting party further stated they observed some of the residents rooms are unclean and unkempt along with the building in disrepair. Resident family interviews and LPA observations reveal residents’ clothes are cleaned and laundered several times a week. Additionally, staff interviews corroborated that the few residents who require it get their sheets laundered daily. Staff interviews revealed that the hallways, common area both inside and out are cleaned in a scheduled manner and as needed. Outside sources who frequent the facility were interviewed and they state resident rooms are mostly free from malodors and when concerns are addressed to the staff, the staff respond in an appropriate manner to address the malodors. A facility tour on three (3) separate visits did not corroborate the unclean or unkempt rooms or the building was in disrepair.

The Department has investigated the above-mentioned allegation and based on observations, interviews conducted, and records reviewed there was insufficient evidence to support that the licensee did not provide sufficient staff to meet residents needs and licensee did not maintain a clean facility. Therefore, this allegation is deemed unsubstantiated.



An exit interview was conducted with Executive Natalie Carlborg to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2