374604684-10-9-2025-08-AS-SJAB-DN5UV2-20251105145421

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604684
Report Date: 10/09/2025
Date Signed: 10/09/2025 02:40:12 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
12/05/2023 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20231205151407

FACILITY NAME:	GROSSMONT GARDENS MEMORY CARE		FACILITY NUMBER:	374604684
ADMINISTRATOR:	SUZETTE JOHNSON		FACILITY TYPE:	740
ADDRESS:	4960 MILLS STREET		TELEPHONE:	(619) 644-1100
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	64	CENSUS: 62	DATE:	10/09/2025
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Natalie Carlborg, Executive Director		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Licensee does not ensure the facility has adequate staff to meet the care needs of residents.
Staff did not ensure resident was provided assistance getting dressed.
Resident was left in soiled clothing for an extended period of time.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver the findings in the above-mentioned complaint allegations. LPA Domingo identified herself and discussed the purpose of the visit with Executive Director Natalie Carlborg.

During the investigation, LPA Domingo collected pertinent resident records as well as facility documentation and conducted interviews with staff, residents, and outside sources.

On 12/05/2023, the department received a complaint alleging Licensee does not ensure the facility has adequate staff to meet the care needs of residents. Records reviewed of staff schedules and time sheets for the past 30 days showed consistent coverage across all shifts, including awake night staff.

(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

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 3

Control Number 08-AS-20231205151407

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: 10/09/2025

NARRATIVE

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LIC9099C 2 of 3

The facility maintains a posted schedule that meets or exceeds the minimum staffing requirements based on the number and needs of residents. Resident care logs reflected timely assistance with activities of daily living (ADLs), medication administration, and supervision.

Staff 1 (S1) confirmed that staffing levels are reviewed weekly and adjusted based on resident acuity and census changes. Staff 2 (S2) reported that staffing is sufficient to meet resident needs and that additional support is brought in when needed. Staff 3 (S3) stated that medication passes and care routines are completed on time and without delay due to staffing.

Resident 1 and 2: Reported that staff are available when needed and provide timely assistance with personal care and supervision.

Outside source 1 (OS1) and Outside source 2 (OS2): Expressed satisfaction with the level of care and stated that staff are responsive and attentive.

LPA observations during the visit, staff were observed assisting residents promptly, engaging in supervision, and maintaining a calm and organized environment. No signs of resident neglect, delayed care, or under staffing were observed.

On 12/05/2023, the department received a complaint alleging Staff did not ensure the resident was assisted in getting dressed. Record review of R1's appraisal/Needs and Services Plan indicated the need for assistance with dressing due to limited mobility. Daily care logs for the past 30 days documented consistent assistance with dressing during morning care routines. No incident reports or complaints were documented regarding refusal or failure to assist with dressing.

S1 confirmed that R1 requires and receives assistance with dressing daily. Staff are assigned specific ADL tasks during each shift. S2 reported that they assist R1 each morning and that the resident is cooperative and appreciative of the help.S3 stated that the resident is always dressed appropriately and has not expressed concerns about lack of assistance.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20231205151407

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: 10/09/2025

NARRATIVE

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LIC9099C 4 of 4

OS1 and OS2 confirmed that staff help them get dressed every morning and that they are satisfied with the care provided. OS1 and OS2 reported no concerns and stated that the resident is always well-groomed and appropriately dressed during visits. LPA observed residents to be clean, well-groomed, and appropriately dressed at the time of the visit. Staff were observed assisting other residents with Activities of Daily Living (ADLs) in a respectful and timely manner.

On 12/05/2023, the department received a complaint alleging resident was left in soiled clothing for an extended period of time. Record Review of R1's Appraisal/Needs and Services Plan indicated the need for assistance with toileting and hygiene due to limited mobility. Daily care logs documented routine checks and assistance with toileting and clothing changes, including overnight care. No incident reports or internal documentation indicated that the resident was left in soiled clothing or experienced skin breakdown due to neglect.

S1 stated that staff are assigned to conduct regular incontinence checks and assist residents with hygiene as needed, including during night shifts. S2 reported that R1 was checked every two hours and changed promptly when needed. No delays in care were reported. S3 confirmed that the resident has not had any skin issues or hygiene related complaints.

OS1 and OS2 denied being left in soiled clothing and stated that staff respond quickly when assistance is needed. OS1 and OS2 reported no concerns about hygiene or care and stated that the resident is always clean and well cared for during visits. LPA observed residents to be clean, well-groomed, and appropriately dressed at the time of the visit. Staff were observed assisting other residents with toileting and hygiene in a timely and respectful manner.

The Department has investigated a complaint with the above allegations. The Department has found that although the allegations may have occurred or be valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur; therefore, the allegations are unsubstantiated. An exit interview was conducted with the Executive Director, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

LIC9099 (FAS) - (06/04)

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