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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601035
Report Date: 02/24/2026
Date Signed: 02/24/2026 01:27:08 PM

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
10/28/2024 and conducted by Evaluator Amy Rodgers
COMPLAINT CONTROL NUMBER: 08-AS-20241028150711
FACILITY NAME:LUCY'S PLACEFACILITY NUMBER:
374601035
ADMINISTRATOR:LUCIA B.TOTANESFACILITY TYPE:
740
ADDRESS:4770 ELM TREE DRIVETELEPHONE:
(760) 806-3873
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:6CENSUS: 1DATE:
02/24/2026
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Rolando Del Rosario, care giverTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Neglect resulting in resident sustaining delayed medical care
INVESTIGATION FINDINGS:
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On 2/24/2026, LPA Amy Rodgers conducted a subsequent visit to deliver findings regarding the above-mentioned allegation. LPA spoke with Rolando Del Rosario , care giver and explained the purpose of the visit. LPA also discussed the report with Administator Melanie Del Rosario over the phone.

Regarding the allegation of Neglect resulting in resident sustaining delayed medical care, R1 had burns due to coffee spilling during breakfast.

During the investigation, staff members and outside souces were interviewed, and records were reviewed.

On 10/25/2024, around 2:45 AM, staff (S1) found R1 on the floor next to R1s bed. S1 assessed R1 for injuries and did not discover any. Around 7:30 AM, S1 gave R1 breakfast which included a cup of coffee. S1 left R1s room momentarily and heard R1 yell. S1 returned to the room and discovered R1 had spilled his/her coffee on the right leg and all over the floor.
(Continued on LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
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 5
Control Number 08-AS-20241028150711
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: LUCY'S PLACE
FACILITY NUMBER: 374601035
VISIT DATE: 02/24/2026
NARRATIVE
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(Continued from LIC9099)
Hospice nurse (RN) instructed facility staff that every time R1 is found on the floor, they should treat it as a fall and call hospice for further instructions. Hospice was not notified on this occasion and R1 remained on the floor for approximately three hours and forty five minutes.
During the interview, S1 said he/she checked R1 for injuries, and did not observe any, and everything looked normal. Another staff, S2, said that S1 told S2 that R1 sustained a burn on the leg about the size of the palm of his/her hand. Hospice was called after.
No first aid was administered to R1 and according to Hospice CNA, R1s burn was covered with a bib when CNA arrived at the facility around 12:00 – 1:00 PM. CNA described R1s burn as red with blistering.
CNA notified RN and came to the facility to evaluate it around 5:00 PM. Once RN observed R1s wound, RN notified R1s primary care physician and called 911. RN said that type of burn would be very painful, and the coffee had to be very hot to cause that type of damage.
R1 went without medical care for approximately 10 ½ hours until paramedics arrived at the facility at 6:05 PM.

Based on interviews which were conducted and record reviews, 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.

The Department has determined this violation resulted in Licensee failed to seek medical services for R1 when R1 had coffee spill causing burns in R1s leg. An immediate Civil Penalty of $500.00 is charged and is noted on the LIC421IM. Currently, according to Health and Safety Code Section 1569.49, an additional civil penalty assessment is under review by the Program Administrator of Community Care Licensing Division.

An exit interview was conducted over the phone with Administrator Melanie Del Rosario as well as Rolando Del Rosario, Rolando Del Rosario,care giver, and a Plan of Correction was jointly developed. A copy of this report, LIC 9099-D, and LIC421IM and the Licensee/Appeal Rights (LIC 9058) were provided to Rolando Del Rosario,care giver, whose signature on this form confirms receipt of documents.

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SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 08-AS-20241028150711
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: LUCY'S PLACE
FACILITY NUMBER: 374601035
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/24/2026
Section Cited
CCR
87465(a)(1)
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(a) A plan for incidental medical .... The plan shall encourage routine medical. care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging.. care appropriate to the conditions and needs of residents.
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The immediate threat was resolved: R1 was sent by emergency service to hospital. LIcensee will provide in-Service training and will be conducted with staff regarding appropriate conditions and needs in relatation to assiting or arranging medical services to residents..
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This was not met as evidenced by:
Based on interviews and records review, Licensee failed to seek medical services for R1 when R1 had coffee spill causing burns in R1s leg which poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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Training will be completed and submitted to LPA Rodgers with sign-in sheet and training topic clearly noted via email by 3/25/2026.
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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: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
10/28/2024 and conducted by Evaluator Amy Rodgers
COMPLAINT CONTROL NUMBER: 08-AS-20241028150711

FACILITY NAME:LUCY'S PLACEFACILITY NUMBER:
374601035
ADMINISTRATOR:LUCIA B.TOTANESFACILITY TYPE:
740
ADDRESS:4770 ELM TREE DRIVETELEPHONE:
(760) 806-3873
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:6CENSUS: 1DATE:
02/24/2026
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Lack of supervision, resident fall resulting in bruising
Lack of supervision, resulting in resident sustaining burns
INVESTIGATION FINDINGS:
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On 2/24/2026, LPA Amy Rodgers conducted a subsequent visit to deliver findings regarding the above-mentioned allegation. LPA spoke with Rolando Del Rosario , care giver and explained the purpose of the visit. LPA also discussed the report with Administator Melanie Del Rosario over the phone.

Regarding the allegation of Lack of supervision, resident fall resulting in bruising, RP stated that a resident (R1) had a fall hours prior with bruising to the right hip.

During the investigation, staff members were interviewed, and records were reviewed.

On 10/25/2024, around 2:45 AM, staff (S1) found R1 on the floor next to R1s bed. S1 assessed R1 for injuries and did not discover any. S1 said R1 did not complain of pain, however, R1 has difficulty expressing pain due to R1s cognitive impairment.
(Continued on Lic9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20241028150711
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: LUCY'S PLACE
FACILITY NUMBER: 374601035
VISIT DATE: 02/24/2026
NARRATIVE
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(Continued from LIC9099)

Facility staff said R1 will occasionally climb out of bed and voluntarily place himself/herself on the floor. Staff stated R1 will occasionally refuse to get up from the floor, so staff will provide R1 a blanket and pillow and make him comfortable on the floor. According to S1, R1 did not refuse to get off the floor on 10/25/2024, and R1 was left on the floor because S1 was concerned R1 may get back out of bed in the evening.

During R1s examination at the hospital on 10/25/2024, R1 had a normal range of motion in all his/her extremities and there was no hip injury discovered.

Regarding the allegation of Lack of supervision, resulting in resident sustaining burns, RP stated that the facility staff gave R1 breakfast which included hot coffee that R1 ended up spilling on himself/herself giving R1 the first and second degree burns on his/her leg.

R1 has no diet restrictions. R1 can feed himself/herself, and R1 drinks coffee every morning with no prior issues. On 10/25/2024, around 7:30 AM, S1 gave R1 breakfast which included a cup of coffee. S1 left R1s room momentarily and heard R1 yell. S1 returned to the room and discovered R1 had spilled his/her coffee on the right leg and all over the floor.

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

An exit interview was conducted with Rolando Del Rosario, care giver, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5