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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604722
Report Date: 07/30/2025
Date Signed: 07/30/2025 06:06:12 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
04/04/2025 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20250404143359
FACILITY NAME:NOVELLUS CLAIREMONT LLCFACILITY NUMBER:
374604722
ADMINISTRATOR:LAIRD, CANDIFACILITY TYPE:
740
ADDRESS:5219 CLAIREMONT MESA BLVD.TELEPHONE:
(858) 292-8044
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:214CENSUS: 85DATE:
07/30/2025
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Excecutive Director, EJ LewisTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff neglect resulted in resident's hospitalization
Staff did not seek medical attention to meet resident's needs
Staff did not meet resident's incontinence needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. Upon arrival, LPA was greeted by Executive Director EJ Lewis. LPA identified herself and explained the purpose of the visit.

Investigation Overview
Community Care Licensing (CCL) initiated an investigation in response to a complaint received on April 4, 2025, alleging that staff neglect resulted in the hospitalization of Resident 1 (R1), that staff did not seek medical attention to meet R1’s needs, and that incontinence care was not provided. A Confidential Names List (LIC 811) was provided to staff to identify R1.

To investigate these allegations, the Department conducted an onsite facility inspection, reviewed facility records and medical documentation, and conducted multiple interviews with facility staff, residents, and external sources. (continue at LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025
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 6
Control Number 08-AS-20250404143359
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: NOVELLUS CLAIREMONT LLC
FACILITY NUMBER: 374604722
VISIT DATE: 07/30/2025
NARRATIVE
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(Continue from LIC9099)

Through these investigative methods, the Department assessed the facility’s compliance with applicable laws and regulations, as well as the quality of care provided to R1 during the period in question.

According to the complaint, on April 3, 2025, at approximately 7:30 a.m., during the administration of morning medications, staff observed a change in R1’s condition and initiated a 911 call. R1 was subsequently transported to the hospital by emergency personnel. The incident report submitted to CCL indicated that R1 exhibited signs consistent with a stroke, including facial drooping on the right side, confusion, and general weakness.

Resident Background
A review of R1’s medical records showed that upon admission to the facility in March 2024, R1 required maximum assistance with all activities of daily living. R1 had multiple chronic medical conditions, including malignant neoplasm of the prostate and bone, a history of urinary tract infections (UTIs), repeated falls, malnutrition, and anemia. The functional needs service plan dated April 5, 2024, stated that R1 was at heightened risk for sudden changes in condition and required close observation and monitoring. The service care plan for R1 also required full assistance with incontinence care, grooming, bathing, dressing, ambulation, transfers, and escorting. Additionally, R1’s Foley catheter was to be managed by an outside home health agency.

Findings
The Department reviewed hospital records and conducted multiple interviews with external sources, which confirmed that R1’s change in condition on April 3, 2025, was due to a severe bacterial infection (sepsis) originating from a UTI. External sources reported that R1 was admitted in a severely deteriorated state and required care in the intensive care unit (ICU) for four days, followed by an additional ten days of hospitalization. R1 also tested positive for COVID-19, was dehydrated, and had multiple pressure ulcers. Interviewees reported that R1 arrived at the hospital saturated in urine from the shoulders down. Additionally, R1 experienced a significant and undocumented weight loss—from 64 kg on March 5, 2025, to 51.7 kg on April 3, 2025. Staff confirmed that this weight loss and overall change in condition were neither observed nor reported to R1’s medical team, as required and missed an opportunity for timely medical intervention. (Continue at LIC9099C)
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 08-AS-20250404143359
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: NOVELLUS CLAIREMONT LLC
FACILITY NUMBER: 374604722
VISIT DATE: 07/30/2025
NARRATIVE
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(Continue from LIC9099C)

Further, the investigation found that there were no records of home health agency visits after March 13, 2025. Staff stated they were unaware of why the visits had ceased, and the investigation could not determine whether the agency formally discontinued services.

Staff interviews consistently revealed concerns about insufficient direct care staffing. Staff interviews consistently indicated that staffing shortages were an ongoing issue during the time of the incident. Management acknowledged the use of an external staffing agency to fill gaps and to compensate for direct care staff shortages. During a visit on April 10, 2025, it was observed that the Executive Director was acting as a medication technician due to staff callouts. Interviews with staff and residents further confirmed that non-direct care staff were frequently pulled to cover care shifts, and medication administration was often delayed due to staffing shortages. While no adverse outcomes from late medication administration were reported, it was confirmed that incontinence care was not provided to R1 before the arrival of emergency personnel on April 3, 2025, due to a short-staffed night shift.
A review of the facility’s staffing schedules for the relevant period could not verify whether all scheduled shifts were adequately staffed, as coverage for unscheduled absences was not consistently documented, and not all the staff involved were available to comment.

As of May 2025, the facility is under new management. The current administration has prioritized increasing staffing levels to ensure sufficient care. Follow-up interviews with staff, residents, and external sources confirmed that current staffing is adequate to meet residents’ needs.

Conclusion
Based on the evidence obtained through interviews, observations, and a review of records, the Department determined that there is sufficient evidence to substantiate the allegations. Staff neglect resulted in R1’s hospitalization, medical attention to meet R1 needs was not appropriately addressed, and incontinence care was not adequately provided to meet R1’s needs.

(Continue on LIC9099C)
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 08-AS-20250404143359
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: NOVELLUS CLAIREMONT LLC
FACILITY NUMBER: 374604722
VISIT DATE: 07/30/2025
NARRATIVE
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(Continue from LIC9099C)


The Department finds the allegations to be substantiated, meeting the preponderance of evidence standard. Deficiencies were cited under Title 22, Division 6, Chapter 8 of the California Code of Regulations, and are detailed on LIC 9099-D. A Plan of Correction (POC) was developed with Executive Director EJ Lewis. In accordance with Health and Safety Code Section 1569.49, an additional civil penalty is under review by the Program Administrator of the Community Care Licensing Division.

An exit interview was conducted with Executive Director Lewis, who was provided with a copy of this report, the LIC 9099-D Deficiency Report, the LIC 811 Confidential Names List, and the LIC 9058 (03/22) Licensee Appeal Rights.
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Citations on this Visit Report are Under Appeal!

Control Number 08-AS-20250404143359
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: NOVELLUS CLAIREMONT LLC
FACILITY NUMBER: 374604722
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
09/01/2025
Section Cited
CCR
87463(e)
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Section 87463 (e) – Reappraisals
The licensee shall immediately, or as soon as reasonably possible, bring any significant change in condition to the attention of the appropriate licensed medical professional. This requirement was not met as evidenced by:

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The licensee agreed to conduct staff training on regulations regarding timely evaluations and reappraisals. Documentation of the training will be submitted to CCL by the POC due date 9/1/2025.
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Based on observations, records review, and interviews with staff and outside sources, staff neglect resulted in the resident's (R1) hospitalization. This posed an immediate health, safety, and personal rights risk to one 1 of 84 residents in care.
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Under Appeal
Type B
09/01/2025
Section Cited
CCR
87466
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Section 87466 – Observation of the Resident. The licensee shall ensure residents are regularly observed…when changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician. This requirement was not met as evidenced by:
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The licensee agreed to ensure adequate staffing levels and provide staff training on monitoring and documenting changes in residents’ conditions. The facility will submit staffing plans and documentation of completed training by the POC due date 9/1/2025.
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Based on observations, records review, and interviews with staff and outside sources, the licensee did not seek medical attention to meet the resident's needs (R1). This posed a potential health, safety, and personal risk to one 1 of 84 residents 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: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Citations on this Visit Report are Under Appeal!

Control Number 08-AS-20250404143359
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: NOVELLUS CLAIREMONT LLC
FACILITY NUMBER: 374604722
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
09/01/2025
Section Cited
CCR
87625(b)(2)
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Section 87625(b)(2) – Managed Incontinence. In addition to Section 87611, …the licensee shall be responsible for the following:
Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement was not met as evidenced by:


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The licensee will provide in-service training on proper incontinence care protocols and submit documentation of staff training by the POC due date 9/1/2025..
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Based on records review, interviews with staff, and outside sources, the licensee did not provide incontinent care to meet R1’s needs. This posed a potential health, safety and personal 4risk to one 1 of 84 residents 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: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6