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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604684
Report Date: 10/20/2025
Date Signed: 10/22/2025 03:28:52 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
12/06/2023 and conducted by Evaluator Amy Domingo
COMPLAINT CONTROL NUMBER: 08-AS-20231206151509
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: 62DATE:
10/20/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Natalie Carlbord, Executive DirectorTIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Due to lack of supervision, residents bother other residents
Staff are not assisting residents with eating
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Domingo conducted a virtual visit, via video conference, to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Executive Director Natalie Carlborg.

The Department's investigation involved unannounced facility tour/welfare checks and review of facility care and medical records. The Department also interviewed relevant staff, clients, and outside sources.

On 12/6/23, it was alleged that due to a lack of supervision, residents bother other residents. The facility provided staffing schedules for the past 30 days, which showed consistent coverage across all shifts. Interviews with staff confirmed that procedures are in place to ensure coverage during call-outs or

Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
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-20231206151509
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: 10/20/2025
NARRATIVE
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emergencies, including the use of on-call staff and agency personnel when necessary. The facility maintains documentation of initial and ongoing training, including topics such as resident rights, supervision, and behavioral management. Staff interviewed demonstrated knowledge of their responsibilities and resident care needs.

LPA interviewed three (3) residents, none of whom reported feeling unsafe or unsupervised. Residents stated that staff are generally available and responsive. No residents reported being bothered by others due to a lack of supervision. LPA interviewed three (2) outside sources, none of whom reported feeling unsafe or unsupervised. Residents stated that staff are generally available and responsive. No outside sources reported their loved ones being bothered by others due to a lack of supervision. During the visit, LPA observed staff actively supervising residents in common areas. No incidents of resident-to-resident conflict were observed, and residents interviewed did not report concerns about supervision.

On 12/6/23, it was alleged that staff are not assisting residents with eating. LPA interviewed [#] staff members, all of whom stated that residents who require assistance with eating are identified in their care plans and are assisted during meals. Staff demonstrated knowledge of residents’ dietary needs and assistance levels. Training records reviewed confirmed that staff received instruction on providing assistance with activities of daily living, including eating, as required

LPA interviewed three (3) residents, including those identified as needing assistance with eating. Residents reported that staff are available during meals and provide help when needed. No residents expressed concerns about being neglected or not receiving assistance during mealtimes. LPA interviewed two (2) outside sources that reported there are staff available during meals and provide help when needed. No outside sources expressed concerns about their loved ones not receiving assistance during meal times.
LPA observed staff assisting residents in a timely and respectful manner. Residents were seated comfortably, and staff were seen offering verbal prompts, physical assistance, and monitoring residents as appropriate. No concerns were noted during the observation period.

The Department has investigated a complaint with the above allegation. 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: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC9099 (FAS) - (06/04)
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