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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604722
Report Date: 08/07/2025
Date Signed: 08/07/2025 04:39:48 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
02/28/2025 and conducted by Evaluator Arian Golbakhsh
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250228100611
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: 89DATE:
08/07/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Executive Director Ernest LewisTIME COMPLETED:
04:35 PM
ALLEGATION(S):
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Staff are mismanaging resident's medication.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced visit to deliver findings regarding the above-mentioned allegation. LPA was welcomed by, identified themselves to, and discussed the purpose of their visit with Executive Director Ernest Lewis.

On 2/28/25, it was alleged that the facility is mismanaging a resident’s (identified as R1) medication. The Department’s investigation consisted of unannounced facility visits, records review, and interviews with staff, residents, and outside sources.

[Continued on LIC 9099C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
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 2
Control Number 08-AS-20250228100611
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: 08/07/2025
NARRATIVE
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[Continued from LIC 9099]

While some staff interviews revealed that the facility has previously had some issues with medication management, no staff members interviewed indicated that R1’s medications were mismanaged. Review of facility records for R1 revealed a documented history of medication refusals, and all staff interviewed corroborated that R1 often did so. Staff interviews and facility records also corroborated that R1 regularly consumed alcohol, despite meetings facilitated by the facility on the risks of R1 mixing alcohol with their specific medications. Resident interviews did not reveal any concerns about medication management or their care. One resident interviewed recalled R1 and revealed that staff would bring medications for R1 routinely. Outside source interviews revealed no concerns about medication management.

Based on interviews and records review, while the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred – therefore the allegations have been determined to be UNSUBSTANTIATED. An exit interview was conducted with Executive Director Lewis to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2