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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372004242
Report Date: 02/11/2026
Date Signed: 02/11/2026 11:42:05 AM

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
02/06/2026 and conducted by Evaluator Janet Ngallo
COMPLAINT CONTROL NUMBER: 08-AS-20260206143548
FACILITY NAME:CARPEL BOARD AND CARE FACILITYFACILITY NUMBER:
372004242
ADMINISTRATOR:CARMONA, LEONORFACILITY TYPE:
740
ADDRESS:2073 HANFORD DRIVETELEPHONE:
(858) 569-1691
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:6CENSUS: 4DATE:
02/11/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee Leonor CarmonaTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff inappropriately restrained resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced visit to initiate a complaint investigation and deliver findings regarding the above mentioned allegation. LPA identified themselves and met with Licensee Leonor Carmona to discuss the purpose of the visit and elements of the complaint.

On 02/06/2026, it was alleged that staff inappropriately restrained a resident. The department's investigation consisted of interviews, records review, and observations.

(Cont. on LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
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 3
Control Number 08-AS-20260206143548
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: CARPEL BOARD AND CARE FACILITY
FACILITY NUMBER: 372004242
VISIT DATE: 02/11/2026
NARRATIVE
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(Cont. from LIC 9099)

Interviews with staff corroborated the allegation. By admission, staff reported that a fabric tie was used to secure Resident 1 (R1) in a wheelchair to prevent them from falling forward. Staff reported that the resident was unable to release the tie independently. Staff stated that the restraint was applied periodically when the resident was seated in the wheelchair and staff were not present to monitor R1 in the living room area. Staff confirmed that the restraint was removed after being advised by a social worker that its use was not permitted.

LPA reviewed R1’s physician report and hospice records. No physician order was found authorizing the use of any postural support for R1. Hospice records revealed that R1 is bed-bound and wheelchair bound, requires one person assistance for transfers, and has upper extremity stiffness. Hospice documentation also noted that caregivers are to receive instruction on fall precautions and safe use of assistive devices.

LPA observed the fabric tie used to secure R1, observed as a scarf-like cloth. Staff demonstrated how the tie was applied around the resident’s lower torso to hold R1's posture in the wheelchair. LPA observed R1 in bed, clean, well-groomed and asleep. Staff showed LPA the wheelchair used by R1 but did not apply the restraint to R1 for demonstration during the visit due to R1 being asleep.

Based on observations, interviews and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.  California code of Regulations, Title 22, Division 6 & Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee Leonor Carmona, whose signature below confirms receipt of these rights.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20260206143548
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: CARPEL BOARD AND CARE FACILITY
FACILITY NUMBER: 372004242
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2026
Section Cited
CCR
87608(a)
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(a)Based on the individual's preadmission appraisal… Postural supports may be used under the following conditions.
This requirement was not met, as evidenced by:

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The Licensee will conduct in-service postural support training with all facility staff and provide a sign-in sheet with signatures and training topic clearly noted to LPA via email by 03/06/2026.
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Based on observations, records review and interviews, licensee did not follow postural support conditions for One(1) out of (Four)4 residents. This posed a potential health and personal rights risks 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: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3