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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604138
Report Date: 04/15/2025
Date Signed: 04/15/2025 08:22:42 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
04/10/2025 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20250410160604
FACILITY NAME:PREMIUM CARE SERVICESFACILITY NUMBER:
374604138
ADMINISTRATOR:HAFIZ, SHEIKHFACILITY TYPE:
740
ADDRESS:8243 HYDRA LNTELEPHONE:
(858) 433-7319
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:6CENSUS: 5DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Staff, Roser LojaTIME COMPLETED:
05:37 PM
ALLEGATION(S):
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Staff are sleeping in residents' room/living room
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit regarding the above mentioned allegation. LPA was greeted and allowed entry into the facility by staff, Khymberlie Talledo. LPA discussed the allegation with Licensee, Sheikh Hafiz via telephone, while at the facility.

During the investigation, the facility was toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged staff are sleeping in residents’ room/living room. It was reported staff use roll away bed and sleep in the living room, as well as on the floor in resident rooms. Resident interviews confirmed staff are sleeping in the living room but not the resident rooms. Staff confirmed they sleep in the living room, as there are no staff rooms available. Licensee confirmed staff are sleeping in the common area/living room, but not resident rooms. The LIC 999 Facility Sketch was reviewed and identified the living room as the intended purpose, not sleeping quarters. By allowing staff to sleep in the living room it precludes the use of the room for the intended purpose. Licensee stated staff will no longer sleep in the common area/living room. Continued on an LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
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-20250410160604
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: PREMIUM CARE SERVICES
FACILITY NUMBER: 374604138
VISIT DATE: 04/15/2025
NARRATIVE
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The facility requires awake staff, l0:00 p.m. to 6:00 a.m. due to a bedridden resident. However, there are three (3) staff available to assist. Therefore, some staff can sleep during those hours.

Based on interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation was found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Staff, Roser Loja whose signature below confirms receipt of these rights.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20250410160604
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: PREMIUM CARE SERVICES
FACILITY NUMBER: 374604138
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2025
Section Cited
CCR
87307(a)
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Personal Accommodations and Services. Living accommodations and grounds shall be related to the facility's function. The facility...accommodations and privacy for the residents, staff, and others who may reside in the facility.This requirement is not met as evidenced by:
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Licensee stated staff will no longer sleep in the common areas/living room. In addition, Licensee agreed to attend training regarding Personal Accommodations and Services and provide proof of training by POC due date.
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Based on interviews, the licensee did not ensure living accommodations were related to the facility's function for 5 out 6 [R1-R5] residents, which posed a potential safety and/or personal rights violation.
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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: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 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
04/10/2025 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20250410160604

FACILITY NAME:PREMIUM CARE SERVICESFACILITY NUMBER:
374604138
ADMINISTRATOR:HAFIZ, SHEIKHFACILITY TYPE:
740
ADDRESS:8243 HYDRA LNTELEPHONE:
(858) 433-7319
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:6CENSUS: 5DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Staff, Roser LojaTIME COMPLETED:
05:37 PM
ALLEGATION(S):
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Staff is serving expired food to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit regarding the above mentioned allegation. LPA was greeted and allowed entry into the facility by staff, Khymberlie Talledo. LPA discussed the allegation with Licensee, Sheikh Hafiz via telephone, while at the facility.

During the investigation, the facility was toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged staff is serving expired food to residents. It was reported that expired food and cooked food over one (1) week old is being served to the residents. LPA observed the food supply in the pantry, fridge, and freezer, there were no expired items. LPA observed food that was prepared by staff, was labeled and dated, along with a cooked leftover meal with today’s date 04/15/25. Staff confirmed they cook daily as it’s advised by the licensee to serve fresh meals. Staff also indicated if the leftover food is not used by the following day, it’s disposed of. Resident interviews confirmed the food being served is fresh and they have not observed any expired food. Resident interviews also reflected the staff cook meals daily. Continued on an LIC 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
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-20250410160604
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: PREMIUM CARE SERVICES
FACILITY NUMBER: 374604138
VISIT DATE: 04/15/2025
NARRATIVE
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The licensee stated he supplies the facility with a sufficient supply of food so that they make fresh meals for the residents. LPA observed a sufficient supply of perishable items for cooking.

During the course of the investigation, interviews were conducted, and observations were made. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Staff, Roser Loja whose signature below confirms receipt of these rights.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5