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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604722
Report Date: 10/07/2026
Date Signed: 10/07/2026 09:37:05 AM

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
10/24/2024 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20241024093250
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: 87DATE:
10/07/2026
UNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Lane HermosilloTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Questionable deaths to residents
Facility did not provide medical attention to residents in care
Facility did not meet the incontinence needs of residents
Staff were not properly trained
Insufficient Staffing
Facility did not treat residents with respect
Facility mismanaged resident medications
Facility did not ensure injections were administered by an appropriately skilled professional
INVESTIGATION FINDINGS:
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On 10/7/2026, Licensing Program Analyst (LPA) Grace Donato conducted a complaint investigation visit to the facility, met with Executive Director Lane Hermosillo, explained the purpose of the visit, and delivered the Department’s findings.

For the allegation of questionable deaths, it was reported that there were three deaths that occurred in the facility in October 2024. According to records review, the facility submitted the death reports. 2 of the death reports submitted were hospice residents. LPA obtained a police report for the other death, and it was deemed a natural death.

On the allegations of Facility did not provide medical attention to residents in care, Facility did not meet the incontinent needs of residents, Staff were not properly trained, Insufficient Staffing, LPA requested documents from the facility but since they have changed systems since the complaint was filed, the facility is not able to provide requested documents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2026
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-20241024093250
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: 10/07/2026
NARRATIVE
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For the allegation of Facility mismanaged resident medications, based on LPA Martinez’ observed stored medication and confirmed the observed medications were not expired. The over stock and discontinued medication stored in a separate office. Within this office, the LPA observed a closet style room where medications were locked and inaccessible, unless door was unlocked with a key.

On the allegation of Facility did not ensure injections were administered by an appropriately skilled professional, LPA Donato attempted to contact staff who were working during the time the complaint was filed but was not able to get any replies. LPA also attempted to locate a contact number for the previous executive director but there is no available contact information.


Based on interviews, records review and observations, the department has determined that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Report is reviewed and copy is provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2