374604204-9-19-2025-08-AS-LTEZ-DM22SJ-20250930173914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604204
Report Date: 09/19/2025
Date Signed: 09/19/2025 04:27:34 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
09/15/2025 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20250915114726

FACILITY NAME:	LA VALHALLA RESIDENTIAL CARE		FACILITY NUMBER:	374604204
ADMINISTRATOR:	DE VERA, JONATHAN		FACILITY TYPE:	740
ADDRESS:	1701 LA VALHALLA PL		TELEPHONE:	(619) 499-5853
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY:	6	CENSUS: 5	DATE:	09/19/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Administrator Jonathan de Vera		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not render resident with timely medical care
Staff did not meet resident’s care needs.
Staff did not treat resident with respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced complaint visit to initiate a complaint investigation on the above-mentioned allegations. LPA met Caregiver Rowena Ramos and discussed the purpose of the visit. LPA spoke with Administrator Jonathan De Vera via facetime and he arrived at the facility.

On September 15, 2025, Community Care Licensing (CCL) received a complaint alleging staff did not provide Resident 1’s (R1) with timely medical care needs, staff did not meet R1’s care needs and staff did not treat R1 with respect. During the investigation, LPA Strong conducted internal and external interviews, and reviewed facility records.

According to the allegation prior to September 13, 2025, Resident 1 (R1) was not rendered timely catheter care needs which resulted in hospitalization.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025

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-20250915114726

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 VALHALLA RESIDENTIAL CARE	FACILITY NUMBER: 374604204
	VISIT DATE: 09/19/2025

NARRATIVE

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Interview with an outside source confirmed R1 was receiving catheter care from home health agency since June of 2025. Records collected revealed R1 has made multiple visits to the emergency department to receive medical care for catheter, dating back to June of 2025. Interview with home health agency confirmed that R1 has been receiving such care. Interview with Administrator established that R1 received emergency medical care on September 12, 2025, as soon as R1 expressed severe pain.

Details of the second allegation state that R1 did not receive nighttime assistance and was left wet due to incontinence. Interview with R1 revealed staff respond to nighttime call systems quickly and continuously. R1 stated there are no issues with nighttime care or routine changes. Staff established that R1 is changed often, throughout the day. Interview with staff revealed that they have not ignored any nighttime calls and have help R1 when asked. Interview with an outside source revealed that there are no concerns with the care received by staff at the facility.

Lastly, it was alleged that R1 was yelled at by nighttime staff. Interview with R1 established that R1 has not been yelled at. Interview with other residents did not reveal any history of verbal abuse. Interview with outside source did not reveal any information to corroborate that facility staff yell at residents.

Based on interviews, and record reviews there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Caregiver Jonathan de Vera, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025

LIC9099 (FAS) - (06/04)

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