374604078-3-2-2026-08-AS-SJAB-DRVPZ4-20260305104452

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604078
Report Date: 03/02/2026
Date Signed: 03/02/2026 07:47:38 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
09/09/2024 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20240909090201

FACILITY NAME:	MARYAM RCFE		FACILITY NUMBER:	374604078
ADMINISTRATOR:	DOST, LEEDA		FACILITY TYPE:	740
ADDRESS:	4930 MAIDEN LANE		TELEPHONE:	(619) 825-7398
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	6	CENSUS: 6	DATE:	03/02/2026
		UNANNOUNCED	TIME BEGAN:	03:40 PM
MET WITH:	Leeda Dost, Administrator		TIME COMPLETED:	04:59 PM

ALLEGATION(S):

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Staff do not treat resident's with dignity.
Staff do not treat resident's with respect.
Licensee is not providing supervision of resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Leeda Dost, Administrator.

The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, Outside Sources, and a review of relevant records. On 9/9/24, Community Care Licensing (CCL) received a complaint alleging the facility staff do not treat resident's with dignity.

LPA interviewed 3 staff members, including caregivers and administrative personnel. All staff consistently stated they have not witnessed or engaged in inappropriate communication with residents. Staff reported they receive ongoing training on resident rights, dignity, and respectful communication as required by Title 22. Staff demonstrated knowledge of facility policies regarding supervision and personal rights.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2026

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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Control Number 08-AS-20240909090201

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: MARYAM RCFE	FACILITY NUMBER: 374604078
	VISIT DATE: 03/02/2026

NARRATIVE

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LPA interviewed residents and they reported they feel respected and treated with dignity by staff. None of the residents interviewed reported hearing staff speak inappropriately or disrespectfully. Residents stated staff respond promptly to their needs and provide supervision when assistance is required. LPA contacted an outside source 1 (OS1). OS1 did not report any concerns regarding staff communication or supervision.

They stated the facility maintains regular communication and provides updates on resident care. During the visit, LPA observed staff interacting with residents in a calm and professional manner. No inappropriate language or disrespectful behavior was observed. Residents appeared comfortable and engaged in activities. LPA reviewed staff training records, resident care plans, and supervision logs. Documentation confirmed staff completed training on personal rights and supervision requirements. Staff schedules indicated adequate coverage to meet residents’ needs.

On 9/9/24, Community Care Licensing (CCL) received a complaint alleging the facility staff do not treat resident's with respect. LPA interviewed staff members regarding their interactions with residents. All staff stated they are trained to uphold residents’ personal rights and treat residents with dignity and respect. Staff described examples of how they provide choices in daily activities, maintain privacy during personal care, and communicate respectfully. No staff admitted or reported observing any disrespectful behavior toward residents.

LPA interviewed residents. Residents consistently reported feeling respected and valued by staff. Residents stated staff address them by their preferred names, listen to their concerns, and provide assistance in a courteous manner. None of the residents reported any incidents of humiliation, neglect, or disrespect. LPA contacted OS1 and they expressed satisfaction with the care provided and did not report any concerns regarding staff treatment of residents. They confirmed that residents appear comfortable and well cared for during visits.

During the visit, LPA observed staff interacting with residents in a professional and respectful manner. Staff were seen assisting residents with activities of daily living while maintaining privacy and dignity. No inappropriate or disrespectful behavior was observed. LPA reviewed staff training records and confirmed completion of courses related to resident rights, dignity, and respectful communication as required by Title 22 and Health & Safety Code. Facility policies reinforce these principles.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2026

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240909090201

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: MARYAM RCFE	FACILITY NUMBER: 374604078
	VISIT DATE: 03/02/2026

NARRATIVE

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On 9/9/24, Community Care Licensing (CCL) received a complaint alleging the Licensee is not providing supervision of residents while in care. LPA interviewed staff members regarding supervision practices. Staff stated they are assigned to specific areas of the facility to ensure residents are monitored and assisted as needed. Staff reported that supervision is maintained through scheduled rounds, activity monitoring, and prompt response to call systems. No staff reported any lapses in supervision.

LPA interviewed residents. Residents stated they feel safe and adequately supervised. Residents reported staff are available when assistance is needed and respond promptly to requests. None of the residents reported being left unattended or without supervision. OS1 did not express concerns regarding supervision. They stated residents appear well cared for and staff presence is evident during visits.

During the visit, LPA observed staff present in common areas and actively engaging with residents. Residents were participating in activities and appeared supervised. No residents were observed unattended in areas that could pose a safety risk. LPA reviewed staff schedules, supervision logs, and facility policies. Documentation confirmed adequate staffing ratios and supervision practices.

Based on observations, interviews, and records reviewed, there is insufficient evidence to support the allegation that lack of supervision resulted in a resident being touched inappropriately. Therefore, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with Leeda Dost, Administrator. to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2026

LIC9099 (FAS) - (06/04)

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