374604860-7-29-2025-08-AS-SJAB-DK4U5P-20250731151703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604860
Report Date: 07/29/2025
Date Signed: 07/29/2025 02:06:51 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
01/23/2025 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20250123135957

FACILITY NAME:	DEL CERRO ELDER CARE		FACILITY NUMBER:	374604860
ADMINISTRATOR:	RATHI, GAURAV		FACILITY TYPE:	740
ADDRESS:	6288 WENRICH DR		TELEPHONE:	(619) 791-5495
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92120
CAPACITY:	6	CENSUS:	DATE:	07/29/2025
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Administrator, Jenny Sequeira		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Neglect resulting in injury
Facility did not afford resident dignity
Facility did not meet resident's incontinence needs
Inappropriate space used for resident's sleep
Inappropriate use of video surveillance

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Amy Rodgers, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. The LPA was greeted by Co-Administrator, Jenny Sequeira , who identified herself and disclosed the purpose of the visit.

On January 23, 2025, Community Care Licensing (CCL) received a complaint alleging the above- mentioned allegations. Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of records review, interviews with facility staff, residents, and family members.
(Continued on LIC 9099)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025

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 3

Control Number 08-AS-20250123135957

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: DEL CERRO ELDER CARE	FACILITY NUMBER: 374604860
	VISIT DATE: 07/29/2025

NARRATIVE

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(Continued from LIC9099) (Page 2 of 3)

Regarding the allegations, neglect resulting in injury and facility did not afford dignity. More specifically, Reporting party (RP) states that R1 has a wound on the right knee for months that reopens because R1 crawls on the floor and R1 complained of pain in her hip. RP further stated they did not observe any injuries. Physician’s Report dated January 20, 2025, states Resident #1 (R1) is non-ambulatory and diagnosed with Parkinson's disease and dementia, and with a history of ataxic gait, dysphonia, cerebrovascular accident. R1 struggles with speech and movement. Interviews were conducted with facility staff, the administrator as well as responsible party. Staff interviews and R1's responsible party confirmed that R1 had a skin condition which was monitored and that appropriate wound care was provided. R1 was observed during the visit and appeared clean alert and responsive. R1 responsible party confirmed R1 occasionally crawled on the floor, and both the staff and the responsible party encourage the use of a wheelchair. They also state that R1 was new to the facility, and the staff were working as a team to address R1's needs, including care related to an undiagnosed brain condition. There is not a preponderance of evidence the facility failed to provide adequate care and uphold our one's personal dignity

Regarding the allegation, facility did not meet resident's incontinence needs and Inappropriate space used for resident's sleep. More specially, R1 incontinence brief was removed and wet and that R1 may have been not been sleeping on their bed.. Interview with administrator reveal staff regularly attempt toileting routines with R1, though these are often unsuccessful. Responsibly party as well as staff interviews reveal R1 often removes incontinence brief due to behavior tendencies. Interviews further reveal R1 has a pattern of crawling off the bed and around their room. LPA observed R1's bed to be positioned as low to the ground as possible, with and additional mat placed on the floor to protect R1 should they leave the bed. Staff explained the mat is to support R1's safety and preference for tight spaces due to behavior factors. A review of records as well as LPA observations reveal that's sufficient staffing is in place to meet residents needs including incontinence care.

(Continued on LIC999C)

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20250123135957

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: DEL CERRO ELDER CARE	FACILITY NUMBER: 374604860
	VISIT DATE: 07/29/2025

NARRATIVE

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(Continued from LIC9099C) ( page 3 of 3)

Regarding the allegation, Inappropriate use of video surveillance. More specifically, there was a surveillance camera in R1's bedroom. According to an interview with R1's responsible party, they confirmed they provided a camera in R1's room. LPA observations of R1's room revealed no camera in the room during a tour. The administrator confirmed there was a camera temporarily placed in R1's room with R1's responsible person's knowledge and consent. The administrator further reported that they took the camera out of R1's room after discussing it with R1's responsible party. Interviews and documentation indicated the camera did not record audio.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed UNSUBSTANTIATED.

A copy of this report along with licensee rights was given to Co-Administrator Jenny Sequeira whose signature below confirms receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025

LIC9099 (FAS) - (06/04)

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