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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 371881394
Report Date: 12/01/2025
Date Signed: 12/01/2025 11:14:12 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/24/2025 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20251124163523
FACILITY NAME:DOLORE HOMEFACILITY NUMBER:
371881394
ADMINISTRATOR:LUONG DAOFACILITY TYPE:
740
ADDRESS:1412 DOLORE PLACETELEPHONE:
(760) 294-9805
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY:6CENSUS: 4DATE:
12/01/2025
UNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Arceli Songco, AdministratorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility has a pest infestation (cockroaches).
INVESTIGATION FINDINGS:
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On 12/01/25 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to commence a complaint investigation in regards to the allegation noted above. LPA met with Arceli Songco, Administrator where LPA explained the purpose of the visit and the elements of the allegation. The allegation was investigated, and the investigation consisted of observations, interviews and records review.

On 11/24/25 Community Care Licensing received a complaint alleging facility has a pest infestation (cockroaches). During today's and shortly after LPAs arrival around 9:28am LPA observed for there to be an unknown pest crawling on the wall inside the den next to the sliding glass door. At 10:10am LPA observed for there to be a live cockroach crawling outside a cabinet above the dishwasher. Additionally inside the kitchen LPA observed for there to be three (3) dead cockroaches, one (1) was a baby, (1) smashed into the tile on the floor, and the other was laying next to the water cooler. LPA conducted an interview with facility staff whom confirmed that the facility does in fact have cockroaches, and that the home was actively being treated by an exterminator
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
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 18-AS-20251124163523
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: DOLORE HOME
FACILITY NUMBER: 371881394
VISIT DATE: 12/01/2025
NARRATIVE
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LPA conducted a records review (email reminder from exterminator company) which revealed that on 11/28/25 the facility was scheduled to be serviced. LPA was provided with a copy of the invoice showing proof confirming that facility was treated. Per an interview with administrator Arceli, the pest control company was coming out on a quarterly basis, until recently (11/28/25), as the problem has been ongoing for about one month concerning to the cockroaches.

Per a records review of service notification forms revealed that prior to the 11/28/25 treatment that facility was last treated on 09/19/25, however it was for an unrelated matter. Per Arceli the recent plan with the exterminator included to take the residents out of the facility, and replace all the food, this allowed for the facility to be serviced on 11/28/25. In addition the resident families have been notified. Based on observation, interviews and records review the allegation of facility has a pest infestation (cockroaches) is substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where a copy of this report, 9099C, 9099D, appeal rights and LIC9098-proof of corrections form was reviewed and provided to Arceli Songco, Administrator.


SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 18-AS-20251124163523
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: DOLORE HOME
FACILITY NUMBER: 371881394
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2025
Section Cited
CCR
87303(a)
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87303 (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: the facility was
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The licensee agreed to show proof of follow up visits until the problem is resolved. Proof of POC is to be submitted to the department by 5pm on the due date indicated.
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observed to have live cockroaches crawling around and staff stated the issue had been for about one month, and an appointment was not scheduled until 11/24/25, which posed a potential health, safety and personal rights risk to persons 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: Carolyn Tuba
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3