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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603870
Report Date: 10/17/2025
Date Signed: 10/17/2025 12:19:12 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
10/06/2025 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20251006105409
FACILITY NAME:LA CRUZ SENIOR CARE, INCFACILITY NUMBER:
374603870
ADMINISTRATOR:CRUZ, LINDAFACILITY TYPE:
740
ADDRESS:1882 EUCLID AVENUETELEPHONE:
(619) 729-1842
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:8CENSUS: 7DATE:
10/17/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Linda CruzTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Licensee did not keep medications stored in original packaging.
Licensee did not give medications as prescribed.
Licensee allowed staff to work before fully meeting background clearance requirements.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced complaint visit to deliver findings in the above-mentioned allegations. LPA met with Administrator Linda Cruz and discussed the purpose of the visit.

Community Care Licensing (CCL) received a complaint alleging licensee did not keep medication stored in original packaging, licensee did not give medication as prescribed, and licensee allowed staff to work before fully meeting background clearance requirements. During the investigation, LPA Strong conducted interviews, conducted a facility inspection and reviewed facility records.

According to the first allegation, on October 3rd, 4th and 5th, license pre-poured multiple doses of medications for residents. Evidence collected revealed that on October 5th, 2025, at 3:19pm, there were morning, noon/dinner, and bedtime medications removed from their original contained and placed in serving cups to be administered at a later time.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
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 5
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
10/06/2025 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20251006105409

FACILITY NAME:LA CRUZ SENIOR CARE, INCFACILITY NUMBER:
374603870
ADMINISTRATOR:CRUZ, LINDAFACILITY TYPE:
740
ADDRESS:1882 EUCLID AVENUETELEPHONE:
(619) 729-1842
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:8CENSUS: 7DATE:
10/17/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Linda CruzTIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee falsified records.
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Iby Strong conducted an unannounced complaint visit to deliver findings in the above-mentioned allegation. LPA met with Administrator Linda Cruz and discussed the purpose of the visit.
Community Care Licensing (CCL) received a complaint alleging license falsified Medication Administration Records (MAR) for October 3, 4 and 5th of 2025. During the investigation, LPA Strong conducted interviews, conducted a facility inspection and reviewed facility records. Interviews conducted with multiple staff revealed that staff were asked by Licensee to sign MARs for medication such staff did not issue. All staff interviewed revealed that they did not sign the MARs requested. Records collected could not corroborate that the MARS were falsified.

Based on interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Administrator, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20251006105409
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: LA CRUZ SENIOR CARE, INC
FACILITY NUMBER: 374603870
VISIT DATE: 10/17/2025
NARRATIVE
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Interviews with multiple staff revealed that they observed the pre-poured medication on such dates. Interview with licensee established that this information was not true.

It was also alleged that licensee did not issue Resident 1’s (R1) medication as prescribed. According to R1’s Physician Report, R1 is unable to administer own medication. Interview with multiple staff revealed that Licensee has instructed staff to issue R1’s narcotic pain medication all at once. Medical prescription revealed that R1 is to receive narcotic pain medication as-needed every four hours. On October 11, 2025, at 8am, LPA Strong observed the medication administration record (MAR) which showed that on October 11, 2025, R1 had issued five doses of their as-needed pain medication all at once. Interviews also revealed that R1 is allowed to store their pre-issued medication in candy containers.

Lastly, it was alleged that multiple staff have been allowed to work prior to meeting their background clearance requirements. Staff schedule collected and medication administration records show there were multiple staff who were not part of the facility roster. Department system records reviewed revealed there were four staff who have not been associated with the facility and one adult who resides at the address who does not have background clearance completed.

Based on interviews, records reviewed and observations, a preponderance of evidence exists to support the allegations. Deficiencies are being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). Additionally, an immediate civil penalty has been issued. An exit interview was conducted with Administrator Linda Cruz, to whom a copy of this report, LIC 9099-C, LIC 9099-D, LIC421 and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20251006105409
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: LA CRUZ SENIOR CARE, INC
FACILITY NUMBER: 374603870
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/17/2025
Section Cited
CCR
87355(e)(2)
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87355 Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department.
Requirement has not been met as in evidence:
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5
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7
Licensee agrees staff will receive their fingerprints by 10/17/2025 by end of business and provide LPA proof.
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14

Based on records reviewed the licensee did not obtain a criminal record clearance in one person residing at the facility which poses an immediate Safety risk to persons in care.
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Type B
10/17/2025
Section Cited
CCR
87355(e)(3)
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87355 (e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or
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Licensee agrees staff will be associated by the end of business today, 10/17/25 and provide LPA proof of such.
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Requirement has not been met as in evidence:
Based on records reviewed the licensee did not obtain a criminal record transfer in four persons working at the facility which poses an potential Safety risk to persons 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: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20251006105409
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: LA CRUZ SENIOR CARE, INC
FACILITY NUMBER: 374603870
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/17/2025
Section Cited
CCR
87465(h)(5)
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87465(h) The following requirements shall apply to medications which are centrally stored:(5)Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.

Requirement was not met as in evidecnce:
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Licensee states they will schedule outside source medication training and provide proof to LPA by end of business day today.
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Based on records reviewed and interviews the licensee did not store medication in original containers which poses an potential Safety risk to persons in care.



· Type B – “posed a potential Health, Safety, or Personal Rights risk to persons in care.”
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Type B
10/17/2025
Section Cited
CCR
87465(2)
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87465(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication.
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Licensee states they will schedule outside source medication training and provide proof to LPA by end of business day today.
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Based on records reviewed and interviews the licensee did not assist R1 with PRN medication as prescribed which posed a potential Safety risk to persons 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: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5