372004738-1-13-2025-08-AS-LTEZ-DDG6UF-20250131200704

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 372004738
Report Date: 01/10/2025
Date Signed: 01/13/2025 08:53:48 AM

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
07/21/2023 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20230721120022

FACILITY NAME:	CANYON VILLAS		FACILITY NUMBER:	372004738
ADMINISTRATOR:	BOLLER, VONDA		FACILITY TYPE:	740
ADDRESS:	4282 BALBOA AVENUE		TELEPHONE:	(858) 273-1306
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92117
CAPACITY:	133	CENSUS: 95	DATE:	01/10/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Chief of Operations Aurora Madueno		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Lack of supervision resulted in sexual abuse

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced follow up complaint investigation visit to deliver complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Chief of Operations Aurora Madueno.

Throughout the investigation, the Department secured records and conducted interviews with external and internal sources, including staff and residents.

It was alleged lack of supervision resulted in sexual abuse. On July 21st, 2023, it was reported to the Department Resident # 1 (R1) was sexually assaulted at the facility, by an unknown male.

R1 was noted to be alert and oriented to person, place, and situation. It was also noted R1 required assistance with Incontinent care, and full assistance with transferring in and out of bed. R1 was not diagnosed with Dementia, but Mild Cognitive Impairment (MCI) was noted. (See LIC 9099C for Continuation).

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

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-20230721120022

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: CANYON VILLAS	FACILITY NUMBER: 372004738
	VISIT DATE: 01/10/2025

NARRATIVE

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Additionally, R1 had an auditory and visual impairment, incontinent of both bowel and bladder, and a motor impairment.

On July 4th, 2023, R1 attended the facility’s BBQ during the day and was witnessed watching the fireworks display in the Baldwin room with other residents.

An interview with R1 revealed the following information. On or about the early morning of July 4th, 2023, R1 was awakened by an unknown male touching R1’s genitals. R1 asked this male what he was doing, without commenting, the unknown male walked out of the room. R1 reported the unknown male was confronted by another male outside R1’s doorway who asked the unknown male what he was doing in that room. R1 heard the other male comment, “what are you doing? this is not your room.” R1 did not call for help, nor push R1’s pendant that was on the night stand at the time. R1 lived independently and did not report the incident until the following morning when R1’s daughter visited. R1 reported feeling safe residing at the facility and felt secured now that R1 doors locked R1's door in the evenings.

Interviews with staff consistently reported there was no male staff working on the shift in question. Staff who reported checking on R1 throughout the evening did not notice anyone walking around the facility late at night. R1 had a night light in the room that was on during the evening, and it illuminated the room, in case R1 got up to use the bathroom. Staff noticed R1 was in R1’s room and did not hear anything unusual. R1’s room was near the medication room and staff would have heard any verbal altercations or disruptions in the hallway.

Interviews with residents, and R1’s neighbors, revealed they did not hear, nor saw anything unusual that evening. Residents reported if there was any type of verbal disturbance in the hallways, they would have heard it, as it was usually quiet at that time. Interviews with R1, R1’s neighbors, and staff confirmed R1 would leave the apartment door open and unlocked. This was also upon R1’s family request.

(See additional LIC 9099C for continuation of report.)

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230721120022

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: CANYON VILLAS	FACILITY NUMBER: 372004738
	VISIT DATE: 01/10/2025

NARRATIVE

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Review of the San Diego Police Department’s (SDPD) Crime/ Incident report corroborated R1 had disclosed the same information about the incident, that was reported to the Department. An officer with SDPD reviewed facility surveillance footage and determined an unknown male entered the facility on the date in question, at approximately 9:42 pm, through the main entrance door. This male was seen exiting the facility at approximately 9:44 pm. Interviewed staff were not able to identify who this male was, and it was noted it could be a family member, or someone dropping off a package, but this was not clear. SDPD submitted a Be on Look Out (BOLO) bulletin of a photo of the unknown male entering the facility, but no one had responded to it. It appeared there was not enough information to continue the police investigation and it would be suspended until additional information was obtained.

Since the incident, the facility placed cameras in the hallways and throughout the building. R1’s bedroom door was now locked. There was no information to support that the unidentified individual in the surveillance footage entered R1's bedroom. There was no information to support that the alleged sexual abuse occurred, and it is unclear who entered R1’s apartment on the evening of July 4th, 2023. Based on the information obtained, the allegation was Unsubstantiated.

An exit interview was conducted with Chief of Operations Aurora Madueno, to whom a copy of this report, LIC 811 Confidential names list, and Licensee/Appeals Rights (LIC 9058), were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

LIC9099 (FAS) - (06/04)

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