374604689-9-22-2025-08-AS-SMAZ-DM288M-20250930221746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604689
Report Date: 09/22/2025
Date Signed: 09/22/2025 02:42:44 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
08/15/2024 and conducted by Evaluator Rebecca A Borunda

COMPLAINT CONTROL NUMBER: 08-AS-20240815112521

FACILITY NAME:	PARKER VILLA		FACILITY NUMBER:	374604689
ADMINISTRATOR:	DERAFERA, MATERESA		FACILITY TYPE:	740
ADDRESS:	629 MICHAEL ST		TELEPHONE:	(619) 625-6886
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY:	6	CENSUS: 6	DATE:	09/22/2025
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Caregiver Raymond Abedoza		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not treat residents with dignity
Staff did not safeguard resident's personal belongings
Staff prohibited resident from consuming alcohol
Unlawful eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Caregiver Raymond Abedoza.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that staff did not treat resident with dignity, staff did not safeguard resident’s personal belongings, staff prohibited resident from consuming alcohol, and staff unlawfully evicted Resident 1 (R1).

Review of admission and assessment records for R1 dated June 2024 revealed that R1 was known to have aggressive and inappropriate behaviors, including inappropriate sexual behaviors, and had a history of alcohol abuse.
Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025

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-20240815112521

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: PARKER VILLA	FACILITY NUMBER: 374604689
	VISIT DATE: 09/22/2025

NARRATIVE

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Incident reports submitted to the Department from the facility revealed that between late June to early July 2024, R1 behaved inappropriately towards staff, including exposing their genitals in common areas, making sexual comments towards staff, and intentionally urinating on staff. Additionally, R1 was noted to consume alcohol and was under the influence of alcohol on multiple occasions. Interviews described R1 as engaging in inappropriate behaviors when under the influence of alcohol and R1 would cause arguments with staff and residents. Incident reports submitted by the facility revealed that on at least one occasion, R1 yelled for approximately 7 hours overnight, which disturbed staff and other residents. While R1 stated that staff spoke to R1 inappropriately, other residents stated that staff handled interactions with R1 in an appropriate manner, including interactions when R1 acting inappropriately or was under the influence of alcohol.

Review of the facility’s admission agreement signed by R1 in June 2024 revealed that facility house rules included a rule that prohibited residents from using alcohol and drugs and prohibited the storage of alcohol in resident rooms, unless the resident had a physician’s order for alcohol. Interviews with R1 and review of R1’s file revealed that R1 did not have a physician's order for alcohol use and R1 was unwilling to request a physician's order for alcohol use. Interviews also revealed that R1 was fully aware of the facility house rule prohibiting alcohol use and R1 continued to consume alcohol while living at the facility despite that knowledge. Interviews with R1 and staff revealed that staff refused to obtain alcoholic beverages for R1 and staff confiscated alcoholic beverages from R1’s room on at least one occasion.

Review of documents received and generated by the Department in July 2024 revealed that on 7/16/2024, the Licensee requested a 3-day eviction for R1 on the basis of R1’s inappropriate sexual behavior and consumption of alcohol, which the Department denied on 7/22/2024. In the 3-day eviction notice denial, the Department notified the Licensee that the 3-day eviction denial did not prevent the Licensee from issuing a 30-day eviction notice. On 7/18/24, the Department received a 30-day eviction notice for R1 on the basis of violating house rules regarding alcohol consumption and courtesy towards other residents and staff. Review of the 30-day eviction notice revealed that the notice met all regulatory requirements. Interviews with R1 and outside sources revealed that the Licensee ensured that R1 and their case manager received a written copy of the 30-day eviction notice.

Continued on LIC9099-C page...

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240815112521

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: PARKER VILLA	FACILITY NUMBER: 374604689
	VISIT DATE: 09/22/2025

NARRATIVE

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R1 stated during an interview that R1 temporarily relocated to another congregate living facility (CLF) in order to live in at a facility that allowed residents to drink alcohol. R1 stated that they were at the CLF for less than 24 hours and had taken some personal belongings, including clothing, to that other facility. R1 stated that they returned to the assisted living facility sometime been 8:00 and 9:00pm and stated that they left their personal belongings at the CLF. The information obtained from R1 was unclear on how R1 traveled to and from the CLF, why R1 was only at the CLF for less than 24 hours, and why R1 left personal belongings at the other facility. Interviews with R1 did not reveal any evidence showing that facility staff caused or influenced R1 to leave their personal belongings at the CLF. R1 did not make any statements that facility staff were involved in R1’s temporary relocation to the CLF outside of a staff member telling R1 about the CLF.

The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated.

An exit interview was conducted with Caregiver Raymond Abedoza, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025

LIC9099 (FAS) - (06/04)

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