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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604829
Report Date: 02/12/2026
Date Signed: 02/17/2026 07:44:48 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
07/10/2025 and conducted by Evaluator Amy Domingo
COMPLAINT CONTROL NUMBER: 08-AS-20250710140105
FACILITY NAME:PARADISE SENIORS LIVING VALLEYFACILITY NUMBER:
374604829
ADMINISTRATOR:CARDONA, BRENDAFACILITY TYPE:
740
ADDRESS:8117 JEFFERSON STTELEPHONE:
(619) 750-8488
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:4CENSUS: 4DATE:
02/12/2026
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Brenda Cardona AdministratorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff did not provide resident medications as prescribed.
Staff did not seek medical attention to resident.
Staff wrongfully evicted resident.
Staff did not provide resident's responsible party an itemized list.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to investigate the above-mentioned complaint allegations. LPA identified herself and discussed the purpose of the visit with Administrator Ms. Cardona.


On July 10, 2025, the Department received a complaint alleging that facility staff failed to administer medications to Resident 1 (R1) as prescribed.

Staff 1 (S1) reported that R1 was admitted on May 19, 2025, and exhibited confusion and resistance to care. S1 acknowledged that R1 did not receive all prescribed medications and that missed or refused doses were not documented. Additionally, no physician was contacted regarding the missed medications.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
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 4
Control Number 08-AS-20250710140105
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: PARADISE SENIORS LIVING VALLEY
FACILITY NUMBER: 374604829
VISIT DATE: 02/12/2026
NARRATIVE
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(Continued from LIC9099)

R1’s physician confirmed that the lack of medication could have contributed to R1’s condition and documented this in the resident’s medical file. Records review revealed no documentation of medication refusals, no physician contact logs, and an incomplete Medication Administration Record (MAR). LPA observations confirmed that the facility did not maintain complete and accurate medication records.

The complaint also alleged that staff did not seek medical attention for resident. Outside Source 1 (OS1) observed that R1 appeared physically weak, disoriented, and unable to walk. OS1 conducted a medication count and determined that prescribed medications had not been administered. Records review confirmed the absence of documentation indicating that medical attention was sought or that the physician was notified.
LPA observations supported that the facility did not respond appropriately to R1’s condition.

The Department also received a complaint alleging that R1 was wrongfully evicted from the facility. S1 stated that the decision to discharge R1 was based on her being “disruptive.” OS1 reported being contacted by S1 on May 22, 2025, and was instructed to immediately pick up R1 from the facility. Records review confirmed that no formal eviction notice was issued to the resident, the responsible party, or Community Care Licensing. LPA observations confirmed that the facility did not follow proper eviction procedures.

The complaint further alleged that the responsible party did not receive an itemized list of R1’s belongings upon discharge.S1 confirmed that no personal property inventory or itemized list was created for R1. OS1 reported that, despite multiple written requests, no itemized list of belongings or charges was provided.
Records review confirmed the absence of documentation related to R1’s personal property. A licensed facility requires licensees to maintain and provide an itemized list of personal property and financial transactions upon discharge.

Based on interviews, observations, and records reviewed, a preponderance of evidence supports the allegations. Therefore, the allegations are SUBSTANTIATED.Deficiencies are cited in accordance with California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A plan of correction was developed in consultation with the Administrator.

An exit interview was conducted with Brenda Cardona, Administrator. A copy of this report, along with the Licensee/Appeal Rights (LIC 9058, 03/22), was provided. The signature below confirms receipt of these documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20250710140105
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: PARADISE SENIORS LIVING VALLEY
FACILITY NUMBER: 374604829
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/13/2026
Section Cited
HSC
1569,683
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Requirement: Licensees must provide a written 30-day eviction notice with specific reasons and notify the Department.

This requirement was not met as evidenced by;
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Administrator agrees to be retrained on Eviction notices. Inform LPA of training registration date.
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Based on interviews, and records reviewed:

The licensee did not provide a written 3 day notice to one of four residents in care
which posed an immediate Health and Safety risk to person in care.
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Type A
02/13/2026
Section Cited
CCR
87465(a)(6)
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The licensee shall ensure that medications are given according to the physician's instructions.

This requirement was not met as evidenced by;
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Administrator agrees to conduct a medication training for all staff and administrator, Inform LPA of training registration date.
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The licensee shall ensure that medications were given according to the physician's instructions in one of four persons in care which posed an immediateHealth and Safety risk to person 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: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20250710140105
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: PARADISE SENIORS LIVING VALLEY
FACILITY NUMBER: 374604829
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/13/2026
Section Cited
CCR
87465(g)
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The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis

This requirement was not met as evidenced by;
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Administrator agrees to conduct a medical emergency training for all staff and administrator, Inform LPA of training registration date.
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Based on observations, interviews, and records reviewed:

The licensee shall seek medical attention for one of four residents in care, which posed a potential Health and Safety risk to person in care.
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Type B
02/27/2026
Section Cited
CCR
87218(a)(1)
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Theft and Loss. The initial personal property inventory shall be completed by the licensee, and the resident, or the resident's representative.

Based on interviews, and records reviewed:
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Administrator agrees to conduct a new admission training for all staff and administrator, Inform LPA of training registration date.
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The licensee did not provide or complete a resident belongings list to one of four residents in care which posed a potential Health and Safety risk to person 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: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4