374604684-3-3-2026-08-AS-APAO-DRX2JA-20260306162602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604684
Report Date: 03/03/2026
Date Signed: 03/03/2026 05:07:59 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
02/26/2026 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20260226092609

FACILITY NAME:	GROSSMONT GARDENS MEMORY CARE		FACILITY NUMBER:	374604684
ADMINISTRATOR:	SCOTT-KAPLIOFF, ANGELA		FACILITY TYPE:	740
ADDRESS:	4960 MILLS STREET		TELEPHONE:	(619) 644-1100
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	64	CENSUS: 60	DATE:	03/03/2026
		UNANNOUNCED	TIME BEGAN:	04:15 PM
MET WITH:	Executive Director Angela Scott- Kapiloff		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff did not ensure the residents' call buttons were not in disrepair

INVESTIGATION FINDINGS:

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LPA Amy Rodgers conducted an unannounced visit to deliver findings regarding the allegation that the facility’s call signal system was not operating properly. LPA identified herself and discussed the allegations mentioned above with Executive Director Angela Scott- Kapiloff.

During the course of the invistigation LPA toured the facility, tested portions of the call system, interviewed staff, received statements from outside sources, and conducted a records review.

(Continued on LIC9099C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2026

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-20260226092609

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: 03/03/2026

NARRATIVE

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LPA Rodgers conducted an unannounced complaint investigation on 02/26/2026 regarding concerns related to the facility’s call signal system. On 02/26/2026 at approximately 1:25 PM, LPA activated a bathroom call cord in the 200 hallway with assistance from maintenance staff. No auditory or visual alert activated. Maintenance staff reported battery replacement in that hallway had not yet been completed.

At approximately 1:43 PM, LPA entered Room 401 and asked the resident to pull the bedside call cord. LPA positioned herself to observe both the resident room and the med tech room. No alert activated, and no staff response occurred. When LPA checked with staff in the Medication room, staff confirmed they did not hear or observe any alert. LPA observation confirmed no alert sound was produced from the computer alert system located in the medication room.

Department interviews with staff reveal inconsistent reports regarding how long the call system had been experiencing intermittent outages.

Despite the malfunctioning call system, Department observations during multiple unannounced visits showed residents to be clean, odor free, groomed, and regularly attended to by staff throughout hallways and common areas. Staff were consistently observed assisting residents with redirection, incontinence care, mobility, and activities. Outside sources who visit the facility frequently also reported that residents are well cared for, clean, and supported by staff. These combined observations do not indicate an immediate threat to the health and safety of residents.

Based on LPA direct observations and interviews and records review, the preponderance of evidence has been met that alleged violation occurred and are therefore substantiated. Deficiencies are cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the licensee.

An exit interview was conducted with Executive Director Angela Scott- Kapiloff, to whom a copy of this report, the LIC9099D and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2026

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20260226092609

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/03/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/04/2026 Section Cited CCR 87303(i)(1)	1 2 3 4 5 6 7	87303 Maintenance and Operation (i)(1)Facilities shall have signal systems which shall meet the following criteria: All facilities licensed for 16 or more.. shall have a signal system...	1 2 3 4 5 6 7	The Administrator reported that the pager system has been repaired and all pagers have been placed back into service. The administrator conducted retraining on 2/27/2026.
	8 9 10 11 12 13 14	This requirement was not met in evidence as: Based on observation/interview/record review the licensee did not maintain a operational signal system for 60 of 60 persons in care which posed a potential Health, Safety, or Personal Rights risk to persons in care	8 9 10 11 12 13 14	The staff has also initiated daily/montly random checks of the signal system to ensure it is functioning properly. Adminsitrator will provide a written letter to LPA to confirm such continous checks by 3/18/2026
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2026

LIC9099 (FAS) - (06/04)

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