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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370808582
Report Date: 11/26/2025
Date Signed: 11/26/2025 11:53:17 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
07/30/2024 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20240730154450
FACILITY NAME:RUBIA'S FACILITY CARE HOMEFACILITY NUMBER:
370808582
ADMINISTRATOR:MERCEDES RUBIAFACILITY TYPE:
735
ADDRESS:12443 OLD POMERADO ROADTELEPHONE:
(858) 397-3030
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 2DATE:
11/26/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Caregiver Leonida De JesusTIME COMPLETED:
11:35 AM
ALLEGATION(S):
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The licensee did not instruct all clients and staff of their duties and responsibilities in a disaster.
Facility did not maintain a current P&I ledger for client's cash resources.
INVESTIGATION FINDINGS:
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LPA Correia conducted an unannounced visit to conclude a complaint investigation. LPA was greeted by Caregiver De Jesus to whom LPA identified herself, was greeted and discussed the purpose of the visit.

The Department's investigation consisted of LPA observations, interviews with facility staff, residents, and outside sources, as well as a review of facility records.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
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 5
Control Number 08-AS-20240730154450
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: RUBIA'S FACILITY CARE HOME
FACILITY NUMBER: 370808582
VISIT DATE: 11/26/2025
NARRATIVE
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It was alleged the Disaster Control Plan. Specifically, interviews conducted with staff and clients were reportedly unaware of their roles and responsibilities during a disaster drill.

It was also alleged that a review of clients’ Personal and Incidental (P&I) ledgers showed non-compliance with regulatory requirements. The review of cash resource ledgers showed facility staff did not record the balance for clients in care.

Based on a review of records, interviews that were conducted with staff and outside sources, and observations, the preponderance of evidence standard has been met. Therefore, the above allegations are determined to be SUBSTANTIATED. Due to time constraints LPA will return on a later date to issue deficiencies.

An exit interview was with Caregiver De Jesus, and a copy of this report and the Licensee Appeal Rights (LIC 9058 03/22) were reviewed with and provided to Licensee Mercedes at the conclusion of the visit. Signature below confirms receipt of these documents.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20240730154450
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: RUBIA'S FACILITY CARE HOME
FACILITY NUMBER: 370808582
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/25/2026
Section Cited
CCR
80026(h)(1)
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Safeguards for Cash Resources… Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following: Records of clients' cash resources maintained as a drawing account, which shall include a current ledger accounting, with columns for income, disbursements and balance, for each client. Supporting receipts for purchases shall be filed in chronological order.
This requirement was not met as evidenced by:
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During today's visit a records review revealed P&I ledgers were complete and accurate.
Deficiency Cleared.
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Based on a review of client records, facility staff did not record the balance on clients in care cash resource ledger.

This posed a potential personal rights risk to 2 out of 2 clients in care.
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Type B
12/25/2025
Section Cited
CCR
80023(c)
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Disaster and Mass Casualty Plan. The licensee shall instruct all clients...and staff, and/or members of the household in their duties and responsibilities under the plan.

This requirement was not met as evidenced by:
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During today's visit staff interviews revealed knowledge of responsibilities and duties during a disaster. Disaster plan and drill was up to date.

Deficiency is cleared.
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Based on interviews with clients’ and facility staff it was revealed they did not know what their duties and responsibilities were during an event of a disaster. Staff interviews revealed inconsistent knowledge of emergency procedures, and client interviews indicated they had not participated in any recent drills or received guidance on evacuation or shelter-in-place protocols.

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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: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5