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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 06:27:16 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
05/29/2024 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20240529111937
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: 69DATE:
07/30/2025
UNANNOUNCEDTIME BEGAN:
01:05 AM
MET WITH:Executive Director, EJ LewisTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Staff did not administer medication as ordered
Not enough staff to meet residents 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 (ED) EJ Lewis, 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 May 29, 2024. The complaint alleged that staff failed to administer medication as ordered and that there was an insufficient number of staff to meet the needs of residents.
To evaluate these allegations, the CCL conducted an onsite inspection of the facility, reviewed facility records, and conducted multiple interviews with staff, residents, and external sources. These investigative methods were used to assess the facility’s compliance with applicable laws and regulations during the relevant time period.
(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: 07/30/2025
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 4
Control Number 08-AS-20240529111937
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)

According to the complaint, residents were receiving their medications late due to a shortage of staff available to administer them. It was reported that between February and May 2024, the facility experienced a shortage of medication technicians and direct care staff. However, no specific details were provided regarding which residents were affected or the specific dates and times when medication was administered late.

Findings
CCL conducted interviews with staff, residents, responsible parties, and external sources, all of which consistently corroborated both allegations.
Staff interviews revealed ongoing concerns regarding inadequate direct care staffing during the period in question. Management acknowledged the use of external staffing agencies to fill gaps and compensate for staffing shortages. During visits conducted on June 3, 2024, and April 10, 2025, LPA observed the Executive Director acting as a medication technician due to staff shortages.

Interviews with staff and residents confirmed that the Executive Director and other non-direct care staff were frequently reassigned to cover care shifts. As a result, medication administration was often delayed. While no adverse health outcomes were reported due to delayed medication, residents’ other care needs were not consistently met.
Interviewees stated that services such as incontinence care, showering, grooming, laundry, and housekeeping were often delayed or incomplete. For example, maintenance staff were observed doing laundry, and housekeeping staff were assisting with food service duties. Management and staff indicated they were making efforts to meet residents’ needs but acknowledged that there were not enough staff available to maintain adequate care. It was further explained that the facility was experiencing challenges in remaining competitive within the industry and had to rely heavily on outside staffing agencies.
As of May 2025, the facility is under new management. The current administration has prioritized increasing staffing levels to ensure resident care needs are met. Follow-up interviews with staff, residents, and external sources confirmed that current staffing is adequate.

(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 4
Control Number 08-AS-20240529111937
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)

Conclusion
Based on the evidence obtained through observations and interviews, CCL substantiates both allegations using 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 the LIC 9099-D form. A Plan of Correction (POC) was developed in coordination with ED EJ Lewis.

An exit interview was conducted with ED Lewis, who was provided with copies of this report, the LIC 9099-D Deficiency Report, 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: 3 of 4
Citations on this Visit Report are Under Appeal!

Control Number 08-AS-20240529111937
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
87465(c)(2)
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87465(c)(2) Incidental Medical and Dental Care
Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by:
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The licensee agreed to conduct in-service training for staff on proper medication administration. Documentation of this training will be submitted to CCL by the POC due date 9/1/2025.
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Based on observations and interviews with staff and external sources, the licensee failed to ensure medications were administered as ordered. This posed a potential health risk to 69 residents in care.
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Under Appeal
Type B
09/01/2025
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements - General
Facility personnel shall at all times be sufficient in numbers and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by:
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The licensee agreed to maintain staffing levels sufficient to meet resident needs and to provide in-service training on resident service care plan requirements. The facility will submit a staffing plan and documentation of the training completed by the POC due date 9/1/2025.
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Based on interviews and observations, the licensee failed to maintain a sufficient number of staff to meet residents’ needs. This posed a potential personal rights risk to 69 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: 4 of 4