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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604684
Report Date: 03/26/2026
Date Signed: 03/26/2026 06:54:23 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
03/23/2026 and conducted by Evaluator Amy Rodgers
COMPLAINT CONTROL NUMBER: 08-AS-20260323143555
FACILITY NAME:GROSSMONT GARDENS MEMORY CAREFACILITY NUMBER:
374604684
ADMINISTRATOR:SCOTT-KAPLIOFF, ANGELAFACILITY TYPE:
740
ADDRESS:4960 MILLS STREETTELEPHONE:
(619) 644-1100
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:64CENSUS: 61DATE:
03/26/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Executive Director Angela Scott- KapiloffTIME COMPLETED:
07:10 PM
ALLEGATION(S):
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Staff did not communicate with resident's authorized representatives
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced visit to investigate and deliver findings regarding the above complaint allegations. LPA introduced themself and disclosed the purpose of the visit to Executive Director Angela Scott-Kapiloff. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, outside sources, and a review of records.
On March 23, 2026, Community Care Licensing Division (CCLD) received a complaint alleging that Resident #1(R1) was hospitalized on 02/01/2026 and subsequently discharged to an unknown rehabilitation center. The authorized representative was not notified of the transfer until 03/23/2026.
Department interviews with staff, as well as a review of facility records, reveal that licensee staff did not report the incident to the resident’s authorized representative (ALW corridinator) within the required timeframe.The delayed reporting impeded care coordination and placed the resident’s continued participation in the Assisted Living Waiver (ALW) program at risk. Based on interviews and records review, a preponderance of evidence supports that the alleged violation occurred; therefore, the allegation is SUBSTANTIATED. A deficiency is cited on the attached LIC 9099D in accordance with California Code of Regulations, Title 22. A Plan of Correction (POC) was jointly developed with the licensee.
An exit interview was conducted with Angela Scott‑Kapiloff, to whom copies of this report, the LIC 811 Confidential Names List, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
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-20260323143555
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: 03/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/26/2026
Section Cited
CCR
87211(a)(1(d)
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87211(a) (1) A written report shall be submitted to the.. person responsible for the resident within seven days of the occurrence..(d) Any incident which threatens the welfare, safety or health of any resident.. This is evidenced by:
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Licensee agrees to retrain all administrative and reporting staff on Title 22 reporting requirements, including timelines and documentation procedures. Proof of staff training, including sign-in sheets and the training materials used, shall be submitted to LPA by 3/26/2026.
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Based on staff interviews and record review, the licensee did not submit a written report of the incident within seven (7) days for 1 of 61 persons in care (R1), to the ALW placement agency which posses risk to the health, safety, and personal rights of persons in care.
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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: 03/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2