370808527-8-14-2025-08-AS-JROO-DQRQVC-20260128113007

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370808527
Report Date: 08/14/2025
Date Signed: 08/14/2025 12:29:22 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
04/29/2025 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20250429083533

FACILITY NAME:	NOAH HOMES, INC.		FACILITY NUMBER:	370808527
ADMINISTRATOR:	SANDRA ROCCO-MELVILLE		FACILITY TYPE:	735
ADDRESS:	12526 CAMPO ROAD		TELEPHONE:	(619) 660-6200
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91978
CAPACITY:	78	CENSUS: 76	DATE:	08/14/2025
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Valarie Davis, Program Coordinator Kimberly Keane, Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Delayed medical care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts(LPAs) Renita Hall and Janet Ngallo conducted an unannounced visit to deliver findings regarding the above-mentioned allegation. LPA was allowed entry by Valarie Davis, Program Coordinator and Kimberly Keane, Administrator. LPA's identified themselves and disclosed the purpose of the visit and elements of the findings to the Administrator.

The investigation included a facility tour, a review of records, and staff interviews.

On 05/30/2025, S1 stated that on 04/26/2025, R1 exhibited cold-like symptoms and was monitored by staff. On 04/28/2025, symptoms worsened, and a telemedicine visit was conducted; over-the-counter Mucinex was prescribed. Later that evening, staff reported R1 was congested. S1 advised moving R1 to the living room. Around 1:00 AM on 04/29/2025, S1 was informed that 911 had been called, and R1 was transported to the hospital.

Continued on 9099 C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025

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-20250429083533

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: NOAH HOMES, INC.	FACILITY NUMBER: 370808527
	VISIT DATE: 08/14/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

S2 reported that on 04/26/2025, R1 developed a fever and was treated with Tylenol and a lukewarm shower per on-call instructions. On 04/28/2025 at 8:00 PM, S2 observed R1’s condition worsening. After attempts to contact S1, S2 called on-call and then 911, resulting in R1’s transport to the hospital.

S3 reported that R1 had been ill for several days and became confused on 04/27/2025. On 04/28/2025, most caregivers believed R1 should be transported immediately, but managers declined. After the managers left, S3 noted R1’s condition did not improve, contacted S1 at 10:30 PM, and was advised to move R1 to the television room for comfort. At 11:58 PM, the on-call delivered a thermometer and blood pressure cuff; vitals were normal, but R1’s breathing worsened. At 12:22 AM on 04/29/2025, S3 called 911, and R1 was transported. S4 was the on-call staff and provided additional medical observations of R1. Based on these observations, S4 determined that R1 was not in distress but was experiencing symptoms of illness. Appropriate steps were taken to ensure R1’s well-being, as R1 was observed drinking fluids, eating, and engaging with staff during this time.

While hospitalized, R1 was intubated twice. After the family established Do Not Resuscitate (DNR) and Do Not Intubate (DNI) orders, R1 passed away. Based on R1’s medical records, R1 had an extensive medical history that contributed to their decline and the development of aspiration pneumonia. There were numerous unsuccessful attempts to contact the Reporting Party (RP); no additional information was obtained. There was no corroborating information in the medical records to indicate the facility was negligent or had delayed medical care.

The investigation concluded that the allegation was unsubstantiated. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted with Valarie Davis, Program Coordinator. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Program Coordinator, and her signature on this report confirms receipt of the Licensee Rights.

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2