<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603450
Report Date: 01/23/2024
Date Signed: 01/23/2024 01:15:28 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
01/16/2024 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20240116150335
FACILITY NAME:GATE MANORFACILITY NUMBER:
374603450
ADMINISTRATOR:ROLANDO CORPUZFACILITY TYPE:
740
ADDRESS:13110 GATE DRIVETELEPHONE:
(844) 320-1497
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 6DATE:
01/23/2024
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Ma.Niza Ambalada, AdministratorTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is understaffed
Staff were unable to communicate with residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to start an investigation on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Ma.Niza Ambalada, Administrator to discuss the purpose of the visit.
LPA conducted interviews, made observations, and obtained and reviewed pertinent records. It was alleged that the facility is understaffed. Interviews revealed there are 3 staff that work at the facility and a floater that works between the three facilities. Interviews revealed there is a cook, a floater and two caregivers. Interviews with staff revealed they are comfortable with the set up of the staff and feel as though they have enough staff. Interviews revealed that the facility could possibly be understaffed but the staff rely on the floater and that the floater helps out a lot. Interviews revealed that it wouldnt hurt to have another staff so the floater is not between all three facilities. There were no complaints from the staff about being understaffed.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
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 2
Control Number 08-AS-20240116150335
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: GATE MANOR
FACILITY NUMBER: 374603450
VISIT DATE: 01/23/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
It was also alleged that the staff were unable to communicate with residents. Interviews revealed that all staff are able to speak english to all the residents and they all understand english. Interviews with staff revealed they are able to communicate with residents and their families. LPA observations revealed all staff spoke english to LPA and residents. Interviews revealed all staff speak Tagalog and English. Interviews with residents revealed they have no issues with communicating with the staff. There were no complaints from the residents that staff is not able to communicate with residents.

Based on the evidence obtained from interviews and records review, the complaint allegations are unsubstantiated. An exit interview was conducted with Ma.Niza Ambalada, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2