Complaint Investigation Report

374604083-1-21-2026-08-AS-SJAB-DQU2RQ-20260130163756

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SAN DIEGO RO , 7575 METROPOLITAN DR. #109

This is an official report of an unannounced visit/investigation of a complaint received in our office on

10/23/2025 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20251023135216

Licensee did not follow reporting requirements

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with Executive Director Topete, to whom LPA disclosed the reason for the visit. On December 31, 2025, it was alleged that the Facility did not follow the reporting requirement regarding a death incident. The Department’s investigation consisted of an unannounced facility visit, interviews with facility staff, and a records review. Resident #1(R1) passed away on 10/14/2025. During the Department's initial visit on 10/24/2025, S1 presented a draft Death Report dated 10/15/2025 for CCLD. CCLD had no record of this report from Licensee, nor did the RO have a record of Licensee verbally reporting the Death of R1. Licensee was required to submit a written incident report to CCLD for S1’s death within seven (7) days of occurrence.The Department investigated the above allegations, and the preponderance of the evidence standard was met. Therefore, the above allegation is substantiated. Deficiency was cited in accordance with the California Code of Regulations, Title 22 and is documented on the attached 9099-D. An exit interview was conducted with Executive Director Topete and a plan of correction was jointly developed. A copy of these reports along with Licensee/Appeal Rights (LIC 9058 03/22) were provided at the conclusion of the visit.