374604138-12-11-2025-08-AS-LTEZ-DQQVNC-20260127153454

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604138
Report Date: 12/10/2025
Date Signed: 12/11/2025 07:58:51 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
12/04/2025 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20251204232010

FACILITY NAME:	PREMIUM CARE SERVICES		FACILITY NUMBER:	374604138
ADMINISTRATOR:	HAFIZ, SHEIKH		FACILITY TYPE:	740
ADDRESS:	8243 HYDRA LN		TELEPHONE:	(858) 433-7319
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	6	CENSUS: 4	DATE:	12/10/2025
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Administrator, Sheikh Hafiz		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not ensure that resident was provided postural support according to their daily living needs
Staff did not provide adequate food service for residents
Staff did not provide residents comfortable living accomodations
Staff did not maintain a comfortable temperature in the facility for residents
Staff did not keep the facility free of cockroaches

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegations mentioned above with Staff, Nelson Quebrel. LPA spoke with Administrator, Sheikh Hafiz via telephone, while at the facility.

During the investigation, the facility was toured, records reviewed, and interviews conducted with staff and residents. It was alleged staff did not ensure Resident #1 (R1) was provided postural support according to their daily living needs and staff did not provide R1 comfortable living accommodations. It was reported R1 did not have bed rails on their bed and was a known fall risk and had an undersized mattress. R1 was not interviewed, as they passed away. The administrator explained that the hospice agency had the hospital bed delivered with a hospital mattress, there were no bed rails or orders. The administrator explained that R1’s physician and/or hospice agency did not order bed rails for R1 because it was not required. Administrator added they will advocate for the residents if the bed rails are needed for mobility use. Continued on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
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 3

Control Number 08-AS-20251204232010

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: 12/10/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Also, administrator stated if a resident is a fall risk, they do not request bed rails for that reason, as that’s not the intended purpose of the bed rail. The administrator went on to explain that hospice provided the hospital bed with a standard mattress, not undersized, and made out of foam, which is not spring loaded like a regular mattress.

It was also alleged staff did not provide adequate food service for residents. It was reported that R1 was not receiving enough food. The administrator explained R1 was on hospice, declining and loss of appetite. R1 was always provided food, however, towards the end of life it was difficult for R1 to eat/swallow. The administrator said they were instructed by hospice to feed R1 but be careful due to choking hazard. Administrator added that R1’s family member was upset, as they wanted R1 to eat more food and eat the items brought by the family. However, the administrator followed hospice instructions for R1’s safety. Today, LPA observed a sufficient supply of food in the fridge, freezer, and pantry. Resident interviews confirmed they are receiving enough food and enjoy the food served. Staff stated they cook daily and provide meal options to the residents.

It was also alleged staff did not maintain a comfortable temperature in the facility for residents. It was reported that on a day when the weather was 90 degrees F., staff only provided non-air-conditioning fans instead of adjusting the room temperature. The facility does not have centralized air conditioning, therefore, the room temperature cannot be adjusted. Today, LPA observed each resident’s room contained a fan, some had a portable window air conditioning units, and there were additional fans in the common areas. Today’s temperature reached 85 degrees F. Some residents were observed wearing sweaters and some using blankets. Resident interviews confirmed the facility was maintained at a comfortable temperature. Also, residents requested the fans not be turned on, as they pointed out they were wearing sweaters. When asked if they felt cold, they explained they were comfortable with their sweaters but did not require the heat to be turned on. The administrator explained they have a sufficient supply of fans. However, when they ask the residents if they would like the fans turned on it’s declined. Continued on LIC 9099C.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
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 3

Control Number 08-AS-20251204232010

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: 12/10/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Lastly, it was alleged staff did not keep the facility free of cockroaches. It was reported an outside source observed a cockroach inside a rice cooker containing uneaten rice. Staff explained they have not observed any cockroaches in food. Staff added the pest control was recently at the facility to spray. The administrator explained they have an annual contract with a professional pest control company. Pest control comes to the facility once a month to spray or more if requested. Resident interviews revealed they have not observed any cockroaches. Staff explained that the pest control company was at the facility two days ago to spray, and staff spray a safe chemical as well for precautionary measures. The facility has measures in place to address cockroaches by having the pest control company on contract.

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

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
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 3