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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603450
Report Date: 01/15/2026
Date Signed: 01/15/2026 11:34:33 AM

Unfounded


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
01/08/2026 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20260108095949
FACILITY NAME:GATE MANORFACILITY NUMBER:
374603450
ADMINISTRATOR:CHARLES THOMASFACILITY TYPE:
740
ADDRESS:13110 GATE DRIVETELEPHONE:
(844) 320-1497
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 5DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Administrator Maniza AmbaladaTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff provided discontinued medication to resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to open a complaint investigation into the above listed allegation. LPA met with Administrator Maniza Ambalada, to whom LPA disclosed the reason for the visit.

During the visit, it was determined Resident1 (R1) did not reside at the facility, therefore the complaint was determined unfounded and dismissed.

An exit interview was conducted with Administrator Ambalada, and copies of this report and Licensee Rights (LIC 9058 01/16) were provided at the conclusion of the visit.

Signature on this form acknowledges receipt of these rights and a copy of this report.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
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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