374602294-12-9-2025-08-AS-SJAB-DPLVXB-20251222154917

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602294
Report Date: 12/09/2025
Date Signed: 12/09/2025 04:24:27 PM

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
12/02/2025 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20251202153935

FACILITY NAME:	SILVERCREEK HOME CARE		FACILITY NUMBER:	374602294
ADMINISTRATOR:	MARIA LEBODA		FACILITY TYPE:	740
ADDRESS:	6530 BOON LAKE AVE		TELEPHONE:	(619) 464-3479
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92119
CAPACITY:	6	CENSUS: 6	DATE:	12/09/2025
		UNANNOUNCED	TIME BEGAN:	11:01 AM
MET WITH:	Administrator Juancho Domingo		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Licensee accepted a resident with a higher level of care needs
Licensee did not follow proper evicition protocols with resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced visit to initiate a complaint investigation on the above-mentioned allegation. LPA identified herself and discussed the purpose of the visit with Layla Vister. Administrator Juancho Domingo arrived shortly after.

On December 2, 2025, Community Care Licensing (CCL) received a complaint alleging the facility unlawfully evicted Resident 1 (R1) and admitted a resident with a higher level of care needs
More specifically, the reporting party stated that the Administrator informed them the facility could not meet R1’s needs and that R1 required a higher level of care and R1 was not allowed to return to the facility after a hospital stay.

investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review.

Staff interviews revealed that R1 exhibited behavioral changes and reported chronic pain, including verbal aggression possibly related to hip pain. Staff stated they were able to meet R1’s needs but became concerned about the rapid behavioral decline.
(Continued on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20251202153935

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: SILVERCREEK HOME CARE	FACILITY NUMBER: 374602294
	VISIT DATE: 12/09/2025

NARRATIVE

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(Continued from LIC9099)

Records review revealed that R1 began residency on 10/24/2025 after discharge from a skilled nursing facility. R1 was hospitalized from 11/3/2025 to 11/11/2025 and again on 11/25/2025. Staff interviews revealed that R1 exhibited behavioral changes and reported chronic pain, including verbal aggression possibly related to hip pain. Staff stated they were able to meet R1’s needs but became concerned about the rapid behavioral decline. Resident interview was not conducted due to R1’s continued hospitalization. Outside source(OS) interviews revealed that R1 was cleared to return to the facility from the hospital on 11/28/2025 following a 3-day hospital stay. on 11/28/2025 the facility Administrator requested a re-evaluation prior to readmission to the facility, citing concerns about R1’s care needs. OS confirmed that a re-evaluation was conducted and R1 remained hospitalized and is still at the hospital on 12/9/2025. No eviction notice was issued to R1 or their responsible party. LPA observations revealed no documentation of an eviction notice and confirmation from the Administrator that R1 will be allowed to return to the facility upon discharge from the hospital.

Based on interviews, direct LPA observations, and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred. Therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Administrator Juancho Domingo, 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: 12/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025

LIC9099 (FAS) - (06/04)

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