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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601276
Report Date: 04/04/2025
Date Signed: 02/09/2026 06:06:47 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
10/01/2021 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20211001153702
FACILITY NAME:ANGEL'S GUEST HOME #1FACILITY NUMBER:
374601276
ADMINISTRATOR:JENKINS, PATRICIAFACILITY TYPE:
740
ADDRESS:9208 BELLAGIO RDTELEPHONE:
(619) 258-2013
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:6CENSUS: 5DATE:
04/04/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Caregiver MarthaTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Facility was not maintained clean and sanitary.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Correia conducted an follow up complaint visit to deliver the finding regarding the above mentioned allegatiion. LPA was greeted at the front entrance by Caregiver Meza, identified herself, and explained the purpose of the visit.

The Department's investigation consisted and a facility tour.

It was alleged the facility was not clean and sanitarty. During the Departments initial visit on October 8, 2021, LPA conducted a facility tour. LPA observed the facility to have accumulated clutter thoughought the premises, the countertops and floors appeared to lack regular sanitation. Additionally, reminents of dead pests were observed in the kitchen cupboards and drawers, as well as the kitchen floor and windowsill.

LPA Correia conducted an exit interview with Caregiver Meza. At the time of the exit interview with Caregiver Meza was given a copy of this report, LIC 9099, LIC 9099-D, and Licensee Rights (LIC9058 01-2016), and signature on this report acknowledges receipt of the rights.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
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 4
Control Number 08-AS-20211001153702
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: ANGEL'S GUEST HOME #1
FACILITY NUMBER: 374601276
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2025
Section Cited
CCR
87303(a)(1)
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The facility shall be clean, safe, sanitary and in good repair at all times. ...maintenance services and procedures for ... employees and visitors. Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition.

This regulation was not met as evidenced by:
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During today's visit LPA observed the facility was well kempt. Staff have put cleaning procedures in place, and the Licensee cleared out a lot of the clutter.

Deficiency had beens cleared.
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Based on LPAs observations the facility had accumalated clutter, and surfaces including counter tops and floors were observed to be unsanitary at the time of visit.

This posed a potential health risk to 5:5 residnets 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: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
10/01/2021 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20211001153702

FACILITY NAME:ANGEL'S GUEST HOME #1FACILITY NUMBER:
374601276
ADMINISTRATOR:JENKINS, PATRICIAFACILITY TYPE:
740
ADDRESS:9208 BELLAGIO RDTELEPHONE:
(619) 258-2013
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:6CENSUS: 5DATE:
04/04/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Caregiver MarthaTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Staff do not assist resident with toileting.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Correia conducted an follow up complaint visit to deliver the finding regarding the above mentioned allegatiion. LPA was greeted at the front entrance by Caregiver Mesa, identified herself, and explained the purpose of the visit.

The Department's investigation consisted of staff and outside source interviews, and a facility tour.

It was alleged facility staff did not assist Resident1 (R1) with toileting. The Licensee revealed R1 became too heavy to lift for assistance with ADLs including incontinence care. The Licensee also revealed there was an incident when R1 was yelling for assistance when they needed to use the commode, but facility staff could not lift them and R1 had an accident on the facility floor. During that time the Licensee activated 911 for assistance. An additional interview conducted with Staff1 (S1) corroborated the Licensees statement. The Licensee also disclosed they met with R1’s Responsible Party (RP) regarding an increased level of care and had an addendum signed by R1's RP. However, there were no available resident records to support the Licensee's statement.
[Continued on LIC 9099C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20211001153702
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: ANGEL'S GUEST HOME #1
FACILITY NUMBER: 374601276
VISIT DATE: 04/04/2025
NARRATIVE
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[Continuation of LIC 9099]

An interview conducted with the Licensee revealed R1's records, who no longer resided at the facility, were buried somewhere in the facility garage and was unable to produce them during the initial visit on October 8, 2021. The Licensee stated R1's file was at the facility, but they needed time to find it. LPA conducted a follow up complaint visit on February 7, 2023, to obtain R1’s records, however the Licensee was still unable to produce R1’s records to aid in the investigation. During an additional visit to the facility on March 23, 2023, the Licensee was still unable to produce R1's records, subsequently during the visit a citation was issued in a case management visit for not being able to produce R1's records per Title 22 regulation.

Due to lack of evidence the above allegation was determined to be Unsubstantiated. An unsubstantiated finding means that although the allegation may have happened there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of this report, Appeal and Licensee Rights (LIC 9058 01/16) were provided to Caregiver Mesa, whose signature below confirm receipt of these rights.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4