374604692-5-13-2025-08-AS-APAO-DGNSR6-20250514140548

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604692
Report Date: 05/13/2025
Date Signed: 05/13/2025 03:12:16 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
05/05/2025 and conducted by Evaluator Hannah Rodgers

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20250505141836

FACILITY NAME:	WESTMONT OF CARMEL VALLEY		FACILITY NUMBER:	374604692
ADMINISTRATOR:	BOEDDEKER, ALLEN		FACILITY TYPE:	740
ADDRESS:	5720 OLD CARMEL ROAD		TELEPHONE:	(858) 465-7356
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92130
CAPACITY:	138	CENSUS: 124	DATE:	05/13/2025
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Resident Services Director Le Sutton		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not ensure quantity of food was sufficient to meet resident's needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to initiate and deliver findings regarding the above complaint allegation. LPA introduced themselves and disclosed the purpose of the visit to Resident Services Director Le Sutton.

On May 5, 2025, it was alleged that staff did not ensure quantity of food was sufficient to meet resident's needs. It was alleged that the facility staff were not providing Resident #1 (R1) food. [See LIC811 Confidential Name List for identification of select person identifiers used in this report]. The Department’s investigation consisted of an unannounced facility visit, records review, and staff, resident, and outside source interviews.

(CONTINUED ON LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

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-20250505141836

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: WESTMONT OF CARMEL VALLEY	FACILITY NUMBER: 374604692
	VISIT DATE: 05/13/2025

NARRATIVE

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Review of R1’s medical assessment records dated March 27, 2025, revealed that R1 had a diagnosis of dementia, was confused/disorientated, exhibited sundowning behaviors, and could feed themselves but required assistance with all other activities of daily living. Review of R1’s service plan date April 1, 2025, revealed that R1 was independent with feeding but required on going care for advanced dementia that caused speech, functional, and behavioral impairments.

LPA conducted a tour of the facility, during the facility’s lunch hour, to which LPA observed three different meal options being provided to the residents. LPA did not observe a lack of food for the residents. Review of the facility’s menu revealed that residents are provided three meals a day with lunch having three different entrée options and dinner consisting of four different entrée options. Interviews with staff revealed that the residents are provided a snack three times a day in addition to a snack station that residents have ongoing access to. Interviews with residents and outside sources did not reveal a concern for an insufficient amount of food to meet residents' needs.

Based on interviews, direct LPA observations and records review, the investigation did not yield a preponderance of evidence to conclude that staff did not ensure quantity of food was sufficient to meet resident's needs. Based on the foregoing, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Resident Services Director Sutton, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

LIC9099 (FAS) - (06/04)

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