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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604692
Report Date: 11/19/2024
Date Signed: 11/19/2024 04:18:49 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/21/2024 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20240621090110
FACILITY NAME:WESTMONT OF CARMEL VALLEYFACILITY NUMBER:
374604692
ADMINISTRATOR:BOEDDEKER, ALLENFACILITY TYPE:
740
ADDRESS:5720 OLD CARMEL ROADTELEPHONE:
(858) 465-7356
CITY:SAN DIEGOSTATE: CAZIP CODE:
92130
CAPACITY:138CENSUS: 103DATE:
11/19/2024
UNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Executive Director Allen "Chad" BoeddekerTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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9
Licensee’s staff did not timely respond to resident signals/alerts.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Allen "Chad" Boeddeker.

The Complainant alleged that between April 2024 and June 2024, Licensee’s staff did not timely respond to residents’ pendant device calls (which are part of the facility’s signals system) to provide them assistance. CCLD’s investigation involved an unannounced facility visit / welfare check and interviews of multiple pertinent staff. The Department also reviewed caregiver work schedules and date and time-stamped electronic data from the facility’s signals system.

[CONTINUED ON LIC 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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 4
Control Number 08-AS-20240621090110
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: WESTMONT OF CARMEL VALLEY
FACILITY NUMBER: 374604692
VISIT DATE: 11/19/2024
NARRATIVE
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[CONTINUED FROM LIC 9099]

CCLD studied the signals data for six (6), randomly selected, twenty-four-hour days, chosen from the complaint allegation period. During the surveyed days, there were a total of 227 resident pendant calls, of which 182 (or 80.2%) were answered by staff in ten (10) minutes or less, and of which 206 (86.3%) were answered by staff in fifteen (15) minutes or less. Work schedules showed that on the surveyed days, Licensee consistently utilized third-party staffing agencies, when needed, to plug/fill staffing vacancies which were not already filled internally by facility caregivers.

Interviews of Medication Technicians and Caregivers showed a pattern of teamwork, communication, and clarity of expectation, as it related to responding to resident signal alerts. Staff interviews and documentation further showed that facility managers met several times per week to review and discuss signals report data, from a quality assurance standpoint.

Based on the totality of records and interviews, a preponderance of evidence does not exist to show that Licensee’s staff did not timely respond to resident signals/alerts. The allegation was therefore Unsubstantiated, and no deficiency was cited for it.

An exit interview was conducted with Boeddeker, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/21/2024 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20240621090110

FACILITY NAME:WESTMONT OF CARMEL VALLEYFACILITY NUMBER:
374604692
ADMINISTRATOR:BOEDDEKER, ALLENFACILITY TYPE:
740
ADDRESS:5720 OLD CARMEL ROADTELEPHONE:
(858) 465-7356
CITY:SAN DIEGOSTATE: CAZIP CODE:
92130
CAPACITY:138CENSUS: 103DATE:
11/19/2024
UNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Executive Director Allen "Chad" BoeddekerTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee’s staff did not arrange medical care for resident.
INVESTIGATION FINDINGS:
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3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Allen "Chad" Boeddeker.

The Complainant alleged that during an incident around mid-May 2024, Licensee’s staff did not arrange emergency medical care for a resident who had a serious fall at the facility. CCLD’s investigation involved an unannounced facility tour and welfare check, interviews of pertinent staff and outside sources, and review of relevant administrative records.

Administrative records and interviews unanimously showed: Person #1 (P1), who fell during the incident, was not a resident of the CCLD-licensed facility. P1 was instead a visitor.

[CONTINUED ON LIC 9099-C]
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20240621090110
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: WESTMONT OF CARMEL VALLEY
FACILITY NUMBER: 374604692
VISIT DATE: 11/19/2024
NARRATIVE
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[CONTINUED FROM LIC 9099]

Interviews showed: After P1 slipped and fell in the facility’s dining room, they told staff they had pain in their hip. There was brief hesitation from facility staff about whether they could call 911 for P1. Ultimately, another visitor of the facility called 911 for P1. (Interviews showed the delay being somewhere between three and ten minutes. The delay was not consequential for P1’s subsequent treatment/recovery).

Based on records and interviews, the allegation that Licensee did not arrange medical care for resident in care is Unfounded, meaning it was false, could not have happened, and/or is without a reasonable basis. The Department has therefore dismissed the allegation, and no deficiency was cited for it.

During today’s visit, LPA provided Technical Assistance (TA) to Licensee regarding CCR 87411 Personnel Requirements – General (refer to the LIC9102 page).

An exit interview was conducted with the Boeddeker, to whom a copy of this report, the LIC9102 page, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4