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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603906
Report Date: 09/12/2025
Date Signed: 12/11/2025 08:16:13 AM

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
08/13/2023 and conducted by Evaluator Amy Domingo
COMPLAINT CONTROL NUMBER: 08-AS-20230813115402
FACILITY NAME:RENAISSANCE LIVINGFACILITY NUMBER:
374603906
ADMINISTRATOR:RICHARD EDWARDSFACILITY TYPE:
740
ADDRESS:9112 WAKARUSA STREETTELEPHONE:
(619) 741-2499
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:6CENSUS: 6DATE:
09/12/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Unique Edwards House Manager/AdministratorTIME COMPLETED:
11:09 AM
ALLEGATION(S):
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Staff engaged in an altercation with resident
Staff left resident on the floor for an extended period of time after falling
Staff inappropriately punished resident
Staff did not adequately manage resident's medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver the findings in the above-mentioned complaint allegations. LPA Domingo identified herself and discussed the purpose of the visit with Unique Edwards Administrator.

During the investigation, LPA Domingo collected pertinent resident records as well as facility documentation and conducted interviews with staff, residents, and outside sources.

On April 20, 2023, it was alleged that staff engaged in an altercation with a resident. Interviews were conducted with two (2) staff members; one staff member denied witnessing or participating in any altercation with a resident. The other staff member provided information that showed staff did not use any methods of redirection or training on de-escalating a resident with dementia. Resident 1 (R1) was

This is an amended report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
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
Control Number 08-AS-20230813115402
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: RENAISSANCE LIVING
FACILITY NUMBER: 374603906
VISIT DATE: 09/12/2025
NARRATIVE
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observed grabbing or pulling on the staff. Staff did not demonstrate knowledge of appropriate de-escalation techniques. Interviews with two (2) residents did not yield any consistent accounts of any altercation. The residents reported that R1 had medical behaviors. R1 was not cooperative with the staff. OS3 was interviewed and stated that the facility staff conducted a pre-appraisal review and stated that they can care for residents with dementia and behaviors related to dementia.

On April 20, 2023, an allegation was made that facility staff left a resident on the floor for an extended period after falling. LPA conducted interviews with staff members who provided statements confirming that they responded promptly to the resident's lying on the floor and followed proper procedures. The staff were aware that the resident has a right to not be forced to get up from the floor. R1 did get up off the floor on their own when they were ready to get up. The LPA interviewed the residents, who confirmed that staff respond quickly to falls and provide necessary assistance. Reviewed incident reports related to falls and found no evidence of staff leaving residents on the floor for extended periods. LPA Domingo verified that staff employed at the time of the report have completed training in emergency response and fall management as per Title 22 regulations.

On April 20, 2023, an allegation was made that facility staff inappropriately punished a resident. LPA Domingo conducted interviews with staff members who confirmed that they follow proper disciplinary procedures and respect resident rights. LPA Domingo interviewed other residents who confirmed that they have not experienced or witnessed inappropriate punishment. Interviews with Outside sources confirmed that they have not witnessed inappropriate punishment or treatment from staff to residents. Records reviewed revealed that staff have resident rights training every year.

On April 20, 2023, an allegation was made that the facility staff did not adequately manage the resident's medication. LPA Domingo conducted interviews with staff members who confirmed that they follow the medication management procedures. Interviews were conducted with two (3) staff members responsible for medication administration. Staff demonstrated knowledge of the facility’s medication policies and procedures, including proper documentation, storage, and administration protocols. Staff confirmed they had received training in medication management as required by Title 22, Section 87465, and were able to articulate steps taken to ensure medication is administered accurately and timely.

(This is an amended report. page 2 of 3)
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20230813115402
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: RENAISSANCE LIVING
FACILITY NUMBER: 374603906
VISIT DATE: 09/12/2025
NARRATIVE
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Interviews with two (2) residents revealed no concerns regarding medication administration. Residents stated that they receive their medications consistently and as prescribed. One resident stated, “They always bring my medication on time and explain what it’s for if I ask.” Outside sources were interviewed, and they all stated that they have no concerns regarding the facility staff administering their medications properly and consistently. A review of Medication Administration Records (MARs) for a sample of residents showed no discrepancies. Medications were documented as administered according to physician orders. No missed doses or errors were identified during the review period. Staff training records confirmed that all personnel responsible for medication administration had completed required training, including annual updates, in accordance with Health and Safety Code and Title 22 regulations.

The department has investigated the above-mentioned complaints. The Department has found that although the allegation may have occurred or be valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur; therefore, the allegations are unsubstantiated.

















This is an amended report page 3 of 3
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20230813115402
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: RENAISSANCE LIVING
FACILITY NUMBER: 374603906
VISIT DATE: 09/12/2025
NARRATIVE
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This page was left blank.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20230813115402
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: RENAISSANCE LIVING
FACILITY NUMBER: 374603906
VISIT DATE: 09/12/2025
NARRATIVE
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This page was left blank
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5