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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604453
Report Date: 11/01/2023
Date Signed: 11/02/2023 07:51:55 AM

Unfounded


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
10/23/2023 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20231023143501
FACILITY NAME:MISSION CAREHOME NORTHFACILITY NUMBER:
374604453
ADMINISTRATOR:ROSEMARIE LIMPINFACILITY TYPE:
740
ADDRESS:2536 NYE STTELEPHONE:
(619) 777-9674
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:6CENSUS: 4DATE:
11/01/2023
UNANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:Caregiver Linda AlforqueTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not administer medication as prescribed.
Licensee took residents personal property
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Iby Strong made an unannounced visit to open an investigation on the above mentioned allegations. LPA identified herself and disclosed the purpose of her visit. LPA met withCaregiver Corona Dumaguing and discussed the basic elements of the complaint. Caregiver Linda Alforque arrived shortly after.

According to allegations, Resident 1 (R1) did not get medication issued as prescribed and R1's personal items were taken from them. During the visit, LPA Strong was able to establish that Resident 1 (R1) is not and was not a resident of this facility.

Therefore the complaint is unfounded. An exit interview was conducted and a copy of Licensee's Rights (LIC 9058 03/22) along with a copy of this report was provided to Caregiver Linda Alforque.
Unfounded
Estimated Days of Completion: 90
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
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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