374603450-9-25-2025-08-AS-RCLK-DMY22K-20251030170053

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603450
Report Date: 09/25/2025
Date Signed: 09/25/2025 07:23:26 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
09/15/2025 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20250915155310

FACILITY NAME:	GATE MANOR		FACILITY NUMBER:	374603450
ADMINISTRATOR:	ROLANDO CORPUZ		FACILITY TYPE:	740
ADDRESS:	13110 GATE DRIVE		TELEPHONE:	(844) 320-1497
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	6	CENSUS: 5	DATE:	09/25/2025
		UNANNOUNCED	TIME BEGAN:	09:38 AM
MET WITH:	Administrator Chuck Thomas		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff hit resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Correia conducted an unannounced visit to commence and conclude a complaint investigation. LPA Correia was met by Administrator Chuck Thomas, identified herself, and explained the purpose of the visit.

During today’s visit LPA conducted staff, resident, and Outside source interviews, and a resident records review.

On September 15, 2025, the Department received a complaint alleging that Staff1 (S1) hit Resident1 (R1). A review of R1’s facility records revealed they were admitted to the facility on February 5, 2022, with diagnoses of schizophrenia, bi-polar disorder, and emphysema. An interview conducted with Outside Source1 (OS1) revealed R1 notified them that S1 had hit their arm. OS1 also revealed they had a meeting with R1 and R1’s Power of Attorney (POA) to discuss the incident. OS1 revealed both they nor the POA saw any bruising or marks on R1.

[Continued on LIC 9099C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

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-20250915155310

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: 09/25/2025

NARRATIVE

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[Continuation from LIC 9099]

The interview with OS1 also disclosed S1 denied ever hitting R1, and stated they were trying to assist R1 change as their clothing was soiled and R1 began yelling and screaming at them.

An interview conducted with the Administrator revealed no knowledge of the incident but has noticed R1’s behaviors seemed to have increased, and R1 was very disrespectful towards staff. An interview conducted with S2 revealed they were not present, however S1 had told them they were trying to assist S1 with changing their clothes and they became agitated and swatted S1’s hands away and began yelling at them. An interview with S3 revealed they were a live-in caregiver and corroborated that R1 would have outbursts of behaviors. All staff interviews revealed never witnessing S1 hit a resident in care.

An interview conducted with R1 revealed that S1 punched them in the head and hit their arm but didn’t know why, and R1 yelled at them and called them names. Interviews conducted with R2 and R3 both revealed the staff at the facility were great, and they were very happy, and neither had been mistreated by staff nor witnessed other residents be mistreated by staff. The interview with R2 also corroborated that R1 yells at the staff, is testy, and can go off their rails at times. [See LIC 811 for confidential names]

Based on interviews and record reviews the above listed allegation was determined Unsubstantiated. This finding means the preponderance of evidence standard was not met.

An exit interview was conducted with Administrator Thomas and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) will be provided at the conclusion of the visit. Signature below confirms receipt of the reports.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

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