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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604796
Report Date: 04/24/2025
Date Signed: 04/24/2025 03:39:34 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
02/27/2025 and conducted by Evaluator Angelica Boyles
COMPLAINT CONTROL NUMBER: 08-AS-20250227152404
FACILITY NAME:EL CAJON ELDER CAREFACILITY NUMBER:
374604796
ADMINISTRATOR:SEQUEIRA, JENIFERFACILITY TYPE:
740
ADDRESS:1412 GROVELAND TERRACETELEPHONE:
(619) 541-3179
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY:6CENSUS: 6DATE:
04/24/2025
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Co-Administrator Jenny SequeiralaterTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff restrained resident
Staff handles resident in a rough manor
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to deliver investigative findings regarding the above mentioned allegation. LPA identified herself, explained the purpose of the visit and nature of the complaint to Co-Administrator Jenny Sequeiralater.

On February 27, 2025 the Department received this complaint which alleged staff restrained Resident #1 (R1) [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] and staff handles R1 in a rough manor. The Department’s investigation included a facility tour, record reviews, as well as interviews with residents, staff and outside sources.

(Continued on LIC9099-C)

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
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-20250227152404
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: EL CAJON ELDER CARE
FACILITY NUMBER: 374604796
VISIT DATE: 04/24/2025
NARRATIVE
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(Continued from LIC9099)

Regarding the allegation of facility staff restraining resident, during LPA interview with R1, R1 was unable to provide any details of the event including when it happened or which staff allegedly restrained them. Records reviewed revealed that R1 has mild cognitive impairment and may often exhibit confused and/or disoriented mental conditions. Per interviews with other residents and outside sources who are familiar with the facility and frequently visit, there have been no witnesses to R1 or any other residents being restrained in any manner.

Regarding the allegation of facility staff handling resident in a rough manor, during LPA interview, R1 did not report ever being treated roughly by staff and reported feeling safe at the facility. LPA observed R1 having good rapport with facility staff. Further, interviews with other residents and outside sources familiar with the facility revealed no witnesses to staff treating R1 or any resident in a rough manner.

The Department has investigated the allegations that staff restrained resident and staff handles resident in a rough manor. Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate these allegations and therefore deemed unsubstantiated.

An exit interview was conducted with Co-Administrator Jenny Sequeiralater, to whom a copy of this report and the Licensee’s Rights (LIC9058 01/16) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
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