Complaint Investigation Report

374602252-5-8-2026-08-AS-SJAB-DTZQ8U-20260512115720

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

12/05/2023 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20231205174438

Lack of supervision resulted in resident on resident altercation.

Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to close out a complaint on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Sierra Navasak, Administrator to discuss the purpose of the visit.

LPA conducted conducted a tour of the facility, and conducted interviewes. It was alleged that lack of supervision resulted in resident on resident altercation. Interviews revealed that staff there was an incident with two residents on or round 12/04/2023. Interviews revealed that Resident 1 (R1) poked R2 with a fork while at the dinner table. Interviews revealed that while the incident took place there was only one staff at the time and they were in the kitchen. Interviews revealed that the staff cannot see the table or residents from the kitchen but they could hear. Interviews revealed another resident took the fork away from R1 while at the table. Interviews revealed that on the day of the incident 2 staff were off which led the facility to only have 1 staff at the time. Interviews revealed that R1 did not go to the hospital for any injury.

Based on the evidence obtained from interviews, the complaint allegation is substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met.

A deficiency is cited per Title 22 California Code of Regulation on the 9099 D page. An exit interview was conducted with Sierra Navasak, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.