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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604267
Report Date: 12/23/2025
Date Signed: 12/24/2025 08:10:35 AM

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
12/18/2025 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20251218094408
FACILITY NAME:CLOISTERS OF THE VALLEY, LLCFACILITY NUMBER:
374604267
ADMINISTRATOR:DISHA FRANCES-HALLFACILITY TYPE:
740
ADDRESS:4171 CAMINO DEL RIO SOUTHTELEPHONE:
(619) 283-2226
CITY:SAN DIEGOSTATE: CAZIP CODE:
92108
CAPACITY:70CENSUS: 62DATE:
12/23/2025
UNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Resident Service Director, Marquetta CorbettTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Medications not given as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegation mentioned above with Resident Service Director, Marquetta Corbett.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff and residents. It was alleged medications were not given as prescribed. It was reported the key to the medication cart was lost, resulting in multiple residents not receiving their medications for two (2) days, 12/04/25 and 12/05/25. The Resident Services Director (RSD) explained that the facility has two (2) medication carts, medication cart #1 and medication cart #2. The lock on medication cart #1 was jammed and they were unable to open the medication cart to dispense resident’s medications. The medication technicians that were interviewed explained the lock on the medication cart was jammed and they contacted Ron’s Pharmacy. However, the individual at Ron’s Pharmacy that was supposed to assist, was unavailable. There were twenty-seven (27) residents that did not receive their medications on 12/04/25. Continued on LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
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-20251218094408
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: CLOISTERS OF THE VALLEY, LLC
FACILITY NUMBER: 374604267
VISIT DATE: 12/23/2025
NARRATIVE
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The RSD explained on 12/05/25 their Maintenance Director was contacted to break open the medication cart, so they could dispense medications. The maintenance director was able to open the medication cart. However, it was not prior to resident’s first AM dose. Therefore, morning medications were not dispensed on 12/05/25. A review of facility Progress Notes dated 12/04/25 indicated the medication cart was locked and/or staff could not open the cart. The RSD explained once the lock was broken on the cart, the cart was stored in a locked room for safety. Medication technician explained Ron’s Pharmacy came out over the weekend and fixed the lock. The RSD explained the lock was not broken open initially on 12/04/25 to obtain the medications, as the facility did not want to damage Ron’s Pharmacy medication cart. Residents were interviewed and stated they were no adverse reactions to not receiving their medications. LPA was advised by staff that the Executive Director was out of the building today. However, The Executive Director was present but did not meet with LPA regarding the compliant investigation. Towards the end of the visit the Executive Director made LPA aware they were out sick when the incident occurred and it was the responsibility of staff to report the issue.

Based on interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is 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 Resident Service Director whose signature below confirms receipt of these rights. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Resident Service Director whose signature below confirms receipt of these rights.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20251218094408
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: CLOISTERS OF THE VALLEY, LLC
FACILITY NUMBER: 374604267
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/24/2025
Section Cited
CCR
87465(a)(4)
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Incidental Medical and Dental Care. The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:
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Resident Service Director stated they will conduct In-Service training regarding medication cart checks and reporting issues. The RSD agreed to provide scheduled date of training by POC due date and submit proof of training within 2 weeks.
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Based on interviews and record review, the licensee did not ensure residents received their prescribed medications for 27 out 62 [R1-R27] residents which posed an immediate health and safety risk to residents in care.
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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: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3