<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600949
Report Date: 10/26/2026
Date Signed: 10/26/2026 09:41:43 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/01/2022 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20221201122548
FACILITY NAME:ANNE'S PLACE IIFACILITY NUMBER:
374600949
ADMINISTRATOR:ANNA OSBORNEFACILITY TYPE:
740
ADDRESS:2690 MARY LANE PLACETELEPHONE:
(760) 522-1989
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 6DATE:
10/26/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Dearme DovarteTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not notify residents authorized representative of residents injury in a timely manner
Staff did not seek medical attention for resident in a timely manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/26/26, LPA Grace Donato conducted an unannounced complaint investigation visit. LPA met with Facility Manager, Dearme Dovarte and explained the purpose of the visit.

During the course of the investigation, staff members were interviewed, and records were reviewed.

Regarding the allegation of Staff did not notify residents authorized representative of residents injury in a timely manner, according to staff interviews, ADM mentioned that the facility always notifies the family member. Another staff (S2) mentioned that the responsible party knows about the wound and visits regularly.

For the allegation of Staff did not seek medical attention for resident in a timely manner, according to records review, home health services were provided on 7/07/21. Home health nurses were aware of the “redness” at R1s’s backside and would check status of the area. The home health nurses were visiting three times a week.

Based on interviews and records review, the department has determined that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Report is reviewed and copy is provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2026
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/01/2022 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20221201122548

FACILITY NAME:ANNE'S PLACE IIFACILITY NUMBER:
374600949
ADMINISTRATOR:ANNA OSBORNEFACILITY TYPE:
740
ADDRESS:2690 MARY LANE PLACETELEPHONE:
(760) 522-1989
CITY:ESCONDIDOSTATE:CAZIP CODE:
92025
CAPACITY:6CENSUS: 6DATE:
10/26/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Dearme DovarteTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent resident from sustaining a severe pressure injury
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/26/26, LPA Grace Donato conducted an unannounced complaint investigation visit. LPA met with Facility Manager, Dearme Dovarte and explained the purpose of the visit.

For the allegation of Staff did not prevent resident from sustaining a severe pressure injury, R1, who developed and sustained a stage III pressure sore while residing at the facility. Records were reviewed and the hospital documented the pressure injury as a stage IV injury on 9/16/21. The staff reported R1as a difficult resident, who would not cooperate or adhere to attempts to implement care and positioning of him/her to alleviate the potential of developing the pressure injury. The staff also reported if R1 declined to participate or cooperate in being positioned or being turned to alleviate pressure to R1s backside, then R1 would not made to adhere as to not violate his/her rights. The licensee reported she was the sole caregiver during overnight hours and would check on R1’s backside every two hours. The Licensee reported she did not discover the severity of the pressure sore until 9/16/21 and reported the sore worsened to that state overnight. The Doctor (DR) reported the pressure wound would not have worsened significantly to a stage III or IV overnight as reported by the Licensee.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20221201122548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ANNE'S PLACE II
FACILITY NUMBER: 374600949
VISIT DATE: 10/26/2026
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
Based on interviews and records review there is sufficient evidence to support that the staff was not able to prevent R1 from sustaining a pressure injury.

At the time of the complaint inspection on 12/2/2022, Licensee was informed that the incident is currently under review and a future civil penalty may apply based on Health and Safety Code § 1569.49.

An immediate civil penalty of $500.00 was issued at this time and a copy of the LIC421IM was given to Dearme Dovarte.

Deficiency of the Residential Care Elderly California Code of Regulations, Title 22, Division 6 is observed and cited on a LIC 9099-D. Failure to correct the deficiencies may result in civil penalties.

Report is reviewed and a copy of the report and Appeal Rights is provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20221201122548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ANNE'S PLACE II
FACILITY NUMBER: 374600949
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/27/2026
Section Cited
CCR
87466
1
2
3
4
5
6
7
87466 Observation of the Resident
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any.
1
2
3
4
5
6
7
The administrator will provide a copy of a signed statement and in-service training for staff acknowledging of the review and understanding of regulation 87466 and to be submitted to LPA by POC deadline.
8
9
10
11
12
13
14
This was not met as evidenced by:
Based on interviews and records review the staff did not observe R1s needs causing R1 to sustain a pressure injury while in care which poses an immediate health, safety, or personal rights risk to clients in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4