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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604791
Report Date: 03/21/2025
Date Signed: 03/23/2025 03:34:27 PM

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
03/14/2025 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20250314165800
FACILITY NAME:SIMA COURT RCFEFACILITY NUMBER:
374604791
ADMINISTRATOR:MASE, DOMINIQUE JOHN O.FACILITY TYPE:
740
ADDRESS:10726 SIMA COURTTELEPHONE:
(619) 405-3586
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:4CENSUS: 0DATE:
03/21/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Licensee Dominique MaseTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Licensee falsified information during the licensing application process.
Licensee did not confirm adequate food for residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Debbie Correia, conducted an unannounced visit to conclude a complaint investigation at the facility. LPA was greeted at the front entrance by Licensee Dominique Mase, identified herself, was granted entry, and explained the purpose of the visit.

The Department's investigation included a facility file and outside source records reviews, interviews conducted with the Licensee and an Outside Source, and a brief tour of the facility.

It was alleged the Licensee submitted false information on the facility license application regarding the percentage of ownership not being equal (50%, each) between two applicants. Based on a file review the facility's ownership was processed at 50% percent per the two (2) applicants. It was also alleged the Licensee did not ensure residents in care received adequate food.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
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 2
Control Number 08-AS-20250314165800
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: SIMA COURT RCFE
FACILITY NUMBER: 374604791
VISIT DATE: 03/21/2025
NARRATIVE
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An interview conducted with Licensee and facility tour confirmed the facility has not had any new admissions since Licensure was granted on August 16, 2024. Further review of facility files revealed the complaint was inadvertently filed on the wrong facility and will be redirected to the appropriate facility location.

Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained the allegations were found to be unfounded. An unfounded determination means that the allegations were false, could not have happened and/or are without a reasonable basis.

An exit interview was conducted with Licensee Mase and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2