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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372004738
Report Date: 10/08/2026
Date Signed: 10/09/2026 04:01:38 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
10/06/2026 and conducted by Evaluator Angelica Boyles
COMPLAINT CONTROL NUMBER: 08-AS-20261006111831
FACILITY NAME:CANYON VILLASFACILITY NUMBER:
372004738
ADMINISTRATOR:BOLLER, VONDAFACILITY TYPE:
740
ADDRESS:4282 Balboa AVETELEPHONE:
(858) 273-1306
CITY:San DiegoSTATE: CAZIP CODE:
92117
CAPACITY:133CENSUS: 86DATE:
10/08/2026
UNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Interim Administrator - Mari PerezTIME COMPLETED:
03:17 PM
ALLEGATION(S):
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Staff do not have sufficient amount of water for residents.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Angelica Boyles and Eryn Kane conducted an unannounced visit to the facility to initiate and deliver investigative findings regarding the above mentioned allegation. LPAs identified themselves, explained the purpose of the visit and nature of the complaint to Interim Administrator Mari Perez.

On October 6, 2026 the Department received this complaint which alleged staff do not have sufficient amount of water for residents. The Department’s investigation included a facility tour as well as interviews with residents and staff.

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2026
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-20261006111831
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: 10/08/2026
NARRATIVE
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(Continued from LIC9099)

During an unannounced visit, LPAs observed sufficient amounts of water accessible to residents throughout the facility. On the first floor LPAs observed a mini fridge in the hallway full of mini bottled waters. The second floor hallway was observed to have a hot and cold water dispenser accessible to residents for use. The second floor also had a conference room that had a table of mini bottled waters. The third floor hallway had a mini fridge of mini bottled waters. Additionally, LPAs observed residents being served water with ice during lunch.

LPAs interviewed residents in care who did not report any concerns regarding not having enough drinking water.

LPAs interviewed staff who reported that water stations in the hallways are refilled on a daily basis.

The Department has investigated the allegation that staff do not have sufficient amount of water for residents. Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate this allegation and therefore deemed unsubstantiated.

An exit interview was conducted with Interim Administrator Mari Perez, to whom a copy of this report and the Licensee’s Rights (LIC9058 01/16) were provided at the conclusion of the visit.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2026
LIC9099 (FAS) - (06/04)
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