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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602864
Report Date: 08/07/2025
Date Signed: 08/07/2025 02:35:48 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
05/14/2025 and conducted by Evaluator Rebecca A Borunda
COMPLAINT CONTROL NUMBER: 08-AS-20250514111838
FACILITY NAME:RANCHO PACIFIC HOME CARE, INCFACILITY NUMBER:
374602864
ADMINISTRATOR:NAVASAK, BRANDONFACILITY TYPE:
740
ADDRESS:4416 SAN JOAQUIN STREETTELEPHONE:
(760) 721-5473
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:6CENSUS: 6DATE:
08/07/2025
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Licensee Monica SiharathTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Administrator was not present at facility a sufficient number of hours
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to conduct follow up and deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Licensee Monica Siharath.

During today's visit, LPA observed residents in care and briefly spoke with the Licensee.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that the Administrator was not present at the facility a sufficient number of hours. Review of the facility’s licensing profile listed Staff 1 (S1) as the Administrator for the facility. [Licensee was provided with an LIC811 Confidential Names List to identify S1] Interviews with the Licensee and residents revealed that S1 was at the facility 3-4 days a week for a few hours during the day and S1 had part-time employment outside of the facility.
Continued on LIC9099-C page...
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
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 08-AS-20250514111838
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: RANCHO PACIFIC HOME CARE, INC
FACILITY NUMBER: 374602864
VISIT DATE: 08/07/2025
NARRATIVE
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S1 was present at the facility in the late evening to provide overnight on-call supervision. Interviews asking about S1’s job responsibilities revealed that S1 provided showers and bed baths for 1 to 2 residents during the day. Interviews with residents and the Licensee revealed that the Licensee was at the facility most days of the week between a couple of hours a day to all day and was also on call. Residents stated they would voice any concerns to the Licensee instead of S1 and noted the Licensee as the owner of the facility. Interviews with the Licensee stated that S1 was responsible for providing direct resident care to one resident and was also responsible for overnight care, completing paperwork and scheduling staff. During visits to the facility on 5/23/2025, 6/5/2025, and 8/7/2025, LPA Borunda interacted with the Licensee to obtain resident and staff records and LPA did not have any interactions with S1. The Department attempted to interview S1 for the investigation, however, S1 did not respond to LPA’s multiple contact attempts. Additionally, review of the Administrator Certificate lists revealed that the Licensee’s most recent Administrator Certificate expired on 1/18/2019 and as of 8/7/2025, the Licensee did not have a current active Administrator Certificate. Interviews with the Licensee confirmed that they did not have a current Administrator Certificate.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency is cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page.

An exit interview was conducted with Licensee Monica Siharath, whose signature below confirms receipt of a copy of this report, LIC811, and the Licensee Appeal Rights (LIC9058 03/22).
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20250514111838
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: RANCHO PACIFIC HOME CARE, INC
FACILITY NUMBER: 374602864
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2025
Section Cited
CCR
87405(a)
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87405(a) … The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section…
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Licensee stated that she will enroll in classes for the Administrator Certificate in order to obtain a valid Administrator Certificate. Licensee will provide proof of enrollment in Administrator Certificate Training to the Department by POC due date of 9/5/2025.
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This requirement has not been met as evidenced by: Based on interview and record review, S1 was not at the facility enough hours to provide facility oversight. This poses a potential personal rights risk to 6 of 6 residents 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: Sabel Martinez
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
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