374603431-2-24-2026-08-AS-SMOA-DRSSET-20260302124915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603431
Report Date: 02/21/2026
Date Signed: 02/24/2026 07:31:49 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
03/22/2022 and conducted by Evaluator Sarah Hurt

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20220322083246

FACILITY NAME:	ACTIVCARE AT ROLLING HILLS RANCH		FACILITY NUMBER:	374603431
ADMINISTRATOR:	BONGHABIH N. SHEY		FACILITY TYPE:	740
ADDRESS:	850 DUNCAN RANCH ROAD		TELEPHONE:	(619) 482-8000
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91914
CAPACITY:	80	CENSUS: 52	DATE:	02/21/2026
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Executive Director Bonghabih, Shey, Smith, and Facility Gereontoligist/ Family Counselor Sophia Anguiano		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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9

Neglect to resident resulting in unexplained serious injury

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on a complaint investigation. LPA Hurt met with Executive Director Bonghabih, Shey, Smith, and Facility Gereontoligist/ Family Counselor Sophia Anguiano, and explained the purpose of today’s visit.

Regarding the allegation Neglect to resident resulting in unexplained serious injury. Resident 1 sustained an unexplained serious injury while in care. The Department reviewed facility records, medical documentation, and conducted multiple staff and resident interviews. Records reflect that on 03/02/2022, Resident 1 was being assisted by a caregiver during a transfer from bed to wheelchair when she sustained a laceration to her left leg. Medical records confirm the injury required 16 staples for closure at Sharp Chula Vista Hospital. The investigation revealed that the facility-provided wheelchair had an exposed sharp metal rod protruding from the torn seat, which likely caused the laceration during the transfer. It was also determined that although Resident 1 had previously been identified as requiring two-person assistance with transfers due to weakness and edema, on the morning of the incident only one caregiver assisted her. Based on records reviewed and interviews conducted, there is sufficient evidence to determine that the facility staff failed to provide adequate care and supervision and failed to ensure that equipment provided to Resident 1 was safe for use. This resulted in a serious injury requiring medical attention. The preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED.

The following deficiencies are being cited (see LIC 9099D) from the California Code of Regulations, Title 22, and the California Health and Safety Code. This incident is currently under review and a future civil penalty may apply based on H&S Code section 1569.49(f). Failure to correct the deficiencies may result in additional civil penalties.

Exit interview conducted with facility staff Executive Director Bonghabih, Shey, Smith, and Facility Gereontoligist/ Family Counselor Sophia Anguiano, and appeal rights provided.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

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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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
03/22/2022 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 08-AS-20220322083246

FACILITY NAME:	ACTIVCARE AT ROLLING HILLS RANCH		FACILITY NUMBER:	374603431
ADMINISTRATOR:	BONGHABIH N. SHEY		FACILITY TYPE:	740
ADDRESS:	850 DUNCAN RANCH ROAD		TELEPHONE:	(619) 482-8000
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91914
CAPACITY:	80	CENSUS: 52	DATE:	02/21/2026
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Executive Director Bonghabih, Shey, Smith, and Facility Gereontoligist/ Family Counselor Sophia Anguiano		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
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5
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7
8
9

Licensee did not arrange medical care for resident

INVESTIGATION FINDINGS:

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9
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12
13

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2026

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 3

Control Number 08-AS-20220322083246

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: ACTIVCARE AT ROLLING HILLS RANCH	FACILITY NUMBER: 374603431
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/22/2026 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	87464 Basic Services (f) Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). The following requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Administrator will ensure maintenance director checks equipment monthly for 3 months to ensure all equipment is safe and in good repair, also In service facility staff on recognizing and reporting any unsafe equipment, and also In Service training with staff on ensuring residents with 2 person assist are transferred safely, and submit to LPA by POC date 02/22/2026.
	8 9 10 11 12 13 14	The facility neglected to provide proper care and supervision of Resident 1 leading to serious injury, which poses an immediate health, safety, or personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2026

LIC9099 (FAS) - (06/04)

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