374604996-4-14-2026-08-AS-SJAB-DTFMSV-20260424095234

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604996
Report Date: 04/14/2026
Date Signed: 04/14/2026 03:34:35 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
01/28/2026 and conducted by Evaluator Angelica Boyles

COMPLAINT CONTROL NUMBER: 08-AS-20260128085925

FACILITY NAME:	ISLAND GROVE GUEST HOME II		FACILITY NUMBER:	374604996
ADMINISTRATOR:	SHAND, HILLEL		FACILITY TYPE:	740
ADDRESS:	12624 WILLOW ROAD		TELEPHONE:	(909) 800-4676
CITY:	LAKESIDE	STATE: CA	ZIP CODE:	92040
CAPACITY:	12	CENSUS: 9	DATE:	04/14/2026
		UNANNOUNCED	TIME BEGAN:	08:43 AM
MET WITH:	Lucero Ochoa - Caregiver		TIME COMPLETED:	02:19 PM

ALLEGATION(S):

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Facility staff did not properly address change in resident’s condition
Facility staff did not assist resident with hygiene as needed
Facility staff did not ensure resident's dietary needs were met
Facility staff did not properly report incident

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 Lucero Ochoa, caregiver. LPA also spoke with Administrator Hillel Shand over the phone.

On January 28, 2026 the Department received this complaint which alleged facility staff did not properly address change in Resident #1’s (R1) condition, facility staff did not assist R1 with hygiene as needed, facility staff did not ensure R1’s dietary needs were met, and facility staff did not properly report an incident. [See LIC811 Confidential Name List for a description of select person identifiers used in this report.]

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: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

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-20260128085925

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: ISLAND GROVE GUEST HOME II	FACILITY NUMBER: 374604996
	VISIT DATE: 04/14/2026

NARRATIVE

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(Continued from LIC9099)

Regarding the allegation that facility staff did not properly address change in R1’s condition, based on observation notes the facility kept on R1, there was nothing indicative of a change of condition throughout the month of January. Interviews with staff also reported not observing any change in condition of R1 until R1 was observed to have seizure like activity which prompted staff to contact emergency medical assistance, which was documented on R1's care notes and in an Incident Report.

Regarding the allegation that facility staff did not assist R1 with hygiene as needed, records reviewed revealed that R1 was assessed to need minimal standby assistance with dressing and personal hygiene care. Interviews with outside sources reported residents always appear to be clean and well groomed. Interviews with residents reported staff ensure their hygiene needs are being met. Further, during LPA unannounced facility visits, LPA observed residents in care to appear clean and well groomed.

Regarding the allegation that facility staff did not ensure resident’s dietary needs were met, according to records reviewed, R1 did not require a special diet and was able to feed himself. Further, R1’s nutrition and hydration plan noted that the administrator and family would be notified if R1’s intake declined for 2 consecutive days, which did not occur per observation notes.

Regarding the allegation that facility staff did not properly report an incident, records reviewed revealed that the facility submitted an Incident Report to the Department regarding the incident involving R1. This report indicated contacting R1’s responsible party. Additional facility records noted contacting R1’s responsible party in regards to the incident.

The Department has investigated the above mentioned allegations. 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 Lucero Ochoa, caregiver, 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: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

LIC9099 (FAS) - (06/04)

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