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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600397
Report Date: 09/18/2025
Date Signed: 09/18/2025 04:05:11 PM

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
08/16/2025 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20250816083053
FACILITY NAME:LYN'S HOME CARE IIFACILITY NUMBER:
374600397
ADMINISTRATOR:LYDIA S. ABILLEFACILITY TYPE:
735
ADDRESS:1365 EL LUGAR STREETTELEPHONE:
(619) 427-1830
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:6CENSUS: 6DATE:
09/18/2025
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Caregiver Victoria “Vicky” AzucenaTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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-Licensee did not keep client medication secured/locked.
-Licensee did not keep client medication in original packaging.
-Licensee’s staff did not timely assist client with medication.
-Licensee’s staff did not display required job skill/knowledge.
-Licensee did not provide client required linens.
-Licensee did not provide client required toiletries.
-Licensee did provide adequate activity supplies.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver findings regarding the above prior complaint allegations. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Victoria “Vicky” Azucena.

The Complainant alleged that Licensee did not keep client medication secured/locked, that Licensee did not keep client medication in original packaging, that Licensee’s staff did not timely assist Client #1 (C1) with medication, that Licensee’s staff did not display required job skill/knowledge, that Licensee did not provide C1 required linens, that Licensee did not provide C1 required toiletries, and that Licensee did provide adequate activity supplies. [See LIC 811 Confidential Names List for a description of select person identifiers used in this report.] CCLD’s investigation involved multiple unannounced facility tours/welfare checks and interviews of C1, multiple relevant housemates, and multiple relevant facility staff. The Department also reviewed care and administrative records relating to C1. [CONTINUED ON LIC 9099-C, 1 of 3]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
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 10
Control Number 08-AS-20250816083053
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: LYN'S HOME CARE II
FACILITY NUMBER: 374600397
VISIT DATE: 09/18/2025
NARRATIVE
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[CONTINUED FROM LIC 9099]

During a 08/22/2025 facility visit, LPA observed that the staff bedroom door was left unlocked, and just inside this door were multiple pill sorter/organizer containers with pills inside. LPA was then able to enter the bedroom and remove/confiscate medications without any of the staff observing him do it. LPA then handed the medications back to staff, instructing them to resecure them inside the locking drawer which Licensee has designated for central medication storage. Interviews of 3 of 3 staff at the facility on 08/22/2025 confirmed that said pills belonged to the clients in care. Interviews of 5 of 5 clients corroborated that the staff typically transferred clients’ medications to these pill organizer containers, from which they were then dispensed to clients, instead of staff keeping the pills in the original pharmacy-labeled blister-pack packaging. (Regulation requires centrally stored medications to be stored “in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.” Regulation also requires that “each client's medication shall be stored in its originally received container.”)

Interviews of multiple managers and staff aligned to show: Staff #1 (S1) had neither formal training nor the skill/knowledge to independently pass medications to the clients. On a day in late July 2021, C1 needed/requested an as-needed (PRN) anti-anxiety medication, but S1 could not dispense said PRN from C1’s blister-pack. C1 had to wait for Staff #3 (S3), who themselves were trained to assist with medications but also away on a grocery store run, to come back to the facility to give C1 their PRN. While S3 ultimately gave C1 their PRN, the incident represented an unnecessary delay in C1 receiving needed medication assistance. A similar delay occurred on 09/13/2025, when S1 was again the lone staff, and S3 had to come back to the facility to give C1 their PRN. The Complainant also claimed that for approximately three weeks from late August 2025 to early September 2025, Licensee had run out of medications to give to C1 and that Licensee’s staff did not timely contact C1’s responsible person or physician to resolve the delay. However, interviews of C1 and relevant staff, along with LPA’s own audit of C1’s prescribed (RP) medication list and blister-packs, showed otherwise (meaning there was not a preponderance of evidence to support that C1 had gone without medication due to running out if pills in inventory).


[CONTINUED ON LIC 9099-C, 2 of 3]
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 10
Control Number 08-AS-20250816083053
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: LYN'S HOME CARE II
FACILITY NUMBER: 374600397
VISIT DATE: 09/18/2025
NARRATIVE
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[CONTINUED FROM LIC 9099-C, 1 of 3]

The Complainant claimed S1 also did not have required English-communication skill/knowledge as it relates to their caregiving job, and that on-call Staff #2 (S2) did not display required skill/knowledge with regard to safe/complaint storage of clients’ medications and with regard to where linen and toiletry supplies are kept within the facility. During interview of S1, LPA found that while S1 was not fluent in English, S1 also had enough English skill to have a conversation and answer LPA’s basic questions. Interviews of 5 of 5 clients showed they both understood S1 when S1 spoke to them, and they also felt understood by S1 when they asked S1 for help. Interviews also showed: During the brief period when S2 was on duty during late July 2025 to cover for the primary caregivers, S2 did not know (and was not taught) that Licensee kept spare/reserve linens and toiletry supplies in the garage. CCLD also found that S2 did not display required skill and/or knowledge regarding safe/compliant storage of clients’ medications.

Interviews of C1 and facility staff further showed: When C1 moved into the facility on 07/18/2025, Licensee issued them just a plain mattress on a bedframe, but did ensure provision of required bed linens (i.e., sheets, blanket, pillows and pillowcases, etc.) or bath linens (i.e., towel, hand towel, and washcloth) for C1, who did not arrive with these items. Licensee also did not ensure provision of required toiletry supplies (i.e., hygiene products, soap, toothbrush, toothpaste, and brush/comb) for C1, who did not arrive with these items. The lack of and need for these items was quickly brought to Licensee’s attention on 07/18/2025, but Licensee took no action to remedy the situation. C1’s RP ultimately purchased and delivered these items to C1. However, Licensee did not reimburse RP for these expenses, despite RP later asking them for reimbursement.

During 3 of 3 site visits during this complaint investigation, LPA did not see facility staff facilitate, encourage, or engage in activities with the clients. LPA inspected the facility’s three (3) existing board games, finding that they contained the minimum required pieces for the games to be played (i.e., they were generally complete and usable). However, 3 of 5 clients interviewed told LPA there were at least 1 or 2 more board/card games they wished the facility had, but which Licensee did not yet provide. While Licensee provided a selection of books, they did not provide “newspapers [and] current magazines,” as required by regulation.

[CONTINUED ON LIC 9099-C, 3 of 3]
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 10
Control Number 08-AS-20250816083053
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: LYN'S HOME CARE II
FACILITY NUMBER: 374600397
VISIT DATE: 09/18/2025
NARRATIVE
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[CONTINUED FROM LIC 9099-C, 2 of 3]

Based on records and interviews, a preponderance of evidence exists to show the Licensee did not keep client medication secured/locked, that Licensee did not keep client medication in original packaging, that Licensee’s staff did not timely assist C1 with medication, that Licensee’s staff did not display required job skill/knowledge, that Licensee did not provide C1 required linens, that Licensee did not provide C1 required toiletries, and that Licensee did provide adequate activity supplies. These seven (7) allegations are therefore Substantiated, and seven (7) deficiencies were cited for them per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D pages). Plans of Correction were jointly developed with the Licensee. Since one of the deficiencies is a repeat violation from within the last twelve (12) months, a civil penalty of $250 was also charged/assessed (refer to the LIC421-FC page).

An exit interview was conducted with Caregiver Victoria “Vicky” Azucena, to whom a copy of this report, the LIC 9099-D pages, the LIC421-FC page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided. A set of these same documents was E-mailed to Licensee and facility management.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 10
Control Number 08-AS-20250816083053
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: LYN'S HOME CARE II
FACILITY NUMBER: 374600397
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2025
Section Cited
CCR
80075(k)(1)
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80075 Health Related Services: “(k) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.” This requirement was not met, as evidenced by:
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On the date LPA observed centrally stored medications being unsecured, staff immediately relocated the medications to a locking drawer, resolving the immediate risk. Licensee then submitted to LPA a training sign-in sheet showing on 08/22/2025, staff had retraining to remind them to store all clients’ medications in the locking drawer, instead of the unlocked staff bedroom. The Plan of Correction is Satisfied.
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Based on LPA observation and interviews, Licensee did not ensure centrally stored medications were kept in a safe and locked place that is not accessible to persons other than employees responsible for their supervision. This posed an immediate health risk to 6 of 6 clients [C1 through Client #6 (C6)] in care.
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Type B
09/18/2025
Section Cited
CCR
80075(k)(5)
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80075 Health Related Services: “(k) The following requirements shall apply to medications which are centrally stored: (5) Each client's medication shall be stored in its originally received container.” This requirement was not met, as evidenced by:
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Licensee submitted to LPA a training sign-in sheet showing on 08/22/2025, staff had retraining to remind them to store all clients’ medications in their originally received pharmacy packaging/container. The Plan of Correction is Satisfied.
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Based on LPA observation and interviews, Licensee did not ensure centrally stored medications were stored in their originally received containers. This posed a potential health risk to 6 of 6 clients [C1 through Client #6 (C6)] in care.
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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: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 10
Control Number 08-AS-20250816083053
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: LYN'S HOME CARE II
FACILITY NUMBER: 374600397
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2025
Section Cited
CCR
80075(b)
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80075 Health Related Services: “(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.” This requirement was not met, as evidenced by:
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Interviews showed that Licensee ultimately gave C1 their PRN medication on the two dates in question, albeit delayed. Licensee since self-determined that they do not plan to have Staff #1 (S1) trained to pass medications. Considering this, effective immediately, Licensee agreed to make staffing arrangements such that S1 is never left alone as the only staff on duty at the facility with client (i.e., there must always be a medication-trained coworker on duty with the clients). The Plan of Correction is Satisfied. CCLD advised Licensee that repeat violations may result in civil penalties.
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Based on interviews, Licensee did not ensure that 1 of 6 clients (C1) was timely assisted as needed with self-administration of their prescription medication. This posed a potential health and personal rights risk to persons in care.
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Type B
10/18/2025
Section Cited
CCR
80056(f)(4)
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80065 Personnel Requirements: “(f) All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance. (4) Assistance with prescribed medications which are self-administered.” This requirement was not met, as evidenced by:
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Licensee submitted to LPA a training sign-in sheet showing on 08/22/2025, staff had retraining to remind of regulatory requirements regarding compliant medication storage. Licensee since self-determined that they do not plan to have Staff #1 (S1) trained to pass medications. Considering this, effective immediately, Licensee agreed to make staffing arrangements such that S1 is never left alone as the only staff on duty at the facility with clients (i.e., there must always be a medication-trained coworker on duty with the clients). Licensee agreed to have Staff #2 (S2) attend the 8-hour medication training course through Polaris pharmacy, and E-mail S2’s completion certificate to LPA, by the POC due date.
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Based on interviews, Licensee did not ensure that 2 of 5 staff (S1 and S2) had knowledge and skill in assistance with prescribed medications with are self-administered, as evidenced by safe and effective job performance. This posed a potential health and personal rights risk to 6 of 6 clients [C1 through Client #6 (C6)] in care.
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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: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 10
Control Number 08-AS-20250816083053
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: LYN'S HOME CARE II
FACILITY NUMBER: 374600397
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2025
Section Cited
CCR
85088(c)(4)
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85088 Fixtures, Furniture, Equipment and Supplies: “(c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. (4) Clean linen in good repair, including lightweight, warm blankets and bedspreads; top and bottom bed sheets; pillow cases; mattress pads; rubber or plastic sheeting, when necessary; and bath towels, hand towels and washcloths.” This requirement was not met, as evidenced by:
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C1’s RP ultimately purchased the needed linens and toiletries for C1. Licensee agreed to provide a one-time reimbursement of $100 to RP, and E-mail LPA once sent, by the POC due date. Licensee since taught Staff #2 (S2) that reserve linen and toiletry supplies are kept in the facility’s garage. Going forward, Licensee agreed to ensure that every client is offered clean linens upon their arrival to the facility, and anytime thereafter that the client needs them.
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Based on interviews, for 1 of 6 clients (C1), Licensee did not ensure provision of clean linen in good repair, to include blankets, bedspreads, bedsheets, pillowcases, and towels. This posed a potential health and personal rights violation to persons in care.
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Type B
10/18/2025
Section Cited
CCR
85088(c)(5)
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85088 Fixtures, Furniture, Equipment and Supplies: “(c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. (5) Feminine napkins, nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb.” This requirement was not met, as evidenced by:
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C1’s RP ultimately purchased the needed linens and toiletries for C1. Licensee agreed to provide a one-time reimbursement of $100 to RP, and E-mail LPA once sent, by the POC due date. Licensee since taught Staff #2 (S2) that reserve linen and toiletry supplies are kept in the facility’s garage. Going forward, Licensee agreed to ensure that every client is offered toiletry supplies upon their arrival to the facility (provided the client does not procure their own), and anytime thereafter that the client needs them.
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Based on interviews, for 1 of 6 clients (C1), Licensee did not ensure provision of feminine products, soaps, toothbrush, toothpaste, and comb/brush. This posed a potential health and personal rights violation to persons in care.
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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: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 10
Control Number 08-AS-20250816083053
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: LYN'S HOME CARE II
FACILITY NUMBER: 374600397
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2025
Section Cited
CCR
85088(g)(1)
1
2
3
4
5
6
7
85088 Fixtures, Furniture, Equipment and Supplies: “(g) The licensee shall provide and maintain the equipment and supplies necessary to meet the requirements of the planned activity program. (1) Such supplies shall include daily newspapers, current magazines and a variety of reading materials.” This requirement was not met, as evidenced by:
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7
Licensee agreed to purchase one Scrabble game, one set of Dominoes, one pack of Uno cards (since these were games that existing clients expressed a desire in playing), and to E-mail a copy of the purchase receipt to LPA, by the POC due date. LPA advised Licensee that The Times of San Diego, The Voice of San Diego, The San Diego Reader, La Presna San Diego, and San Diego Magazine are local free publications. Licensee agreed going forward to maintain a changing selection of newspapers and magazines for client use.
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14
Based on LPA observation and interviews, Licensee did not provide and maintain the supplies necessary to meet the requirements of the planned activity program, to include newspapers and current magazines. This posed a potential personal rights risk to 6 of 6 clients [C1 through Client #6 (C6)] in care.
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7
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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: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 10
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
08/16/2025 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20250816083053

FACILITY NAME:LYN'S HOME CARE IIFACILITY NUMBER:
374600397
ADMINISTRATOR:LYDIA S. ABILLEFACILITY TYPE:
735
ADDRESS:1365 EL LUGAR STREETTELEPHONE:
(619) 427-1830
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:6CENSUS: 6DATE:
09/18/2025
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Caregiver Victoria “Vicky” AzucenaTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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5
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7
8
9
Licensee did not provide clients healthful/balanced meals.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Victoria “Vicky” Azucena.

The Complainant alleged that Licensee did not provide clients healthful/balanced meals. CCLD’s investigation involved unannounced facility tours/welfare checks on three (3) separate days to observe multiple meals and snacks served. The Department also relied on interviews of relevant clients and staff.

Based on the totality of LPA’s observations of food served to clients during his visits on 08/22/2025, 09/16/2025, and 09/18/2025: While processed foods with lower nutritional values were served on some occasions, there were also multiple homecooked meals served that included vegetables and fruits. LPA also observed the presence of fresh vegetables in the facility’s refrigerator. [CONTINUED ON LIC 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 9 of 10
Control Number 08-AS-20250816083053
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: LYN'S HOME CARE II
FACILITY NUMBER: 374600397
VISIT DATE: 09/18/2025
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[CONTINUED FROM LIC 9099-A]

Interviews of 5 of 5 clients showed overall, these persons believed Licensee tended to serve them healthy and balanced meals. The clients were generally complimentary of the food served to them.

Based on records and interviews, a preponderance of evidence does not exist to show that Licensee did not provide clients healthful/balanced meals. The allegation is therefore Unsubstantiated, and no deficiency was cited for it.

An exit interview was conducted with Caregiver Victoria “Vicky” Azucena, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided. A set of these same documents was E-mailed to Licensee and facility management.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 10 of 10