374602620-4-23-2025-08-AS-SJAB-DG8US8-20250430154954

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602620
Report Date: 04/22/2025
Date Signed: 04/23/2025 11:21:24 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
02/04/2025 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20250204113009

FACILITY NAME:	PINE TREE HOME, LLC		FACILITY NUMBER:	374602620
ADMINISTRATOR:	SIMSUANGCO, LEONARDO		FACILITY TYPE:	740
ADDRESS:	4603 RAINIER AVENUE		TELEPHONE:	(619) 310-6966
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92120
CAPACITY:	6	CENSUS: 5	DATE:	04/22/2025
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Licensee/Administrator Chona Simsuangco		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff yells at resident
Staff hits resident
Staff interacts with residents in an inappropriate manner
Staff threatens resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Rodgers made an unannounced visit to open an investigation on the above-mentioned allegation. LPA identified herself and disclosed the purpose of her visit with Licensee/Administrator Chona Simsuangco

On February 4th 2025 , Community Care Licensing (CCL) received a complaint alleging Staff 1 (S1) yells, hits, and acts inappropriately to clients and that S1 threatens Client #4(C4). During the investigation, LPA Rodgers made observations, conducted interviews, reviewed facility records, and interviewed outside sources.

Regarding the allegation staff yells, hits and interacts with residents inappropriately. More specifically, it was reported staff #1(S1) yells at Client #1(C1) to move faster when walking; S1 flicks Client#3(C3) in the mouth; and S1 gives clients in the facility the middle finger when they are not looking. (continued on LIC 9099)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025

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-20250204113009

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: PINE TREE HOME, LLC	FACILITY NUMBER: 374602620
	VISIT DATE: 04/22/2025

NARRATIVE

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Continued form 9099) Physician's report dated (8/20/2024) reveals C1 has history of hearing loss. C1 interview denies feeling uncomfortable when any staff asks them to hurry to the waiting transportation outside. Interviews with Client #2(C2) verify that C1 is hard of hearing and staff does talk loudly to C1. Interviews with staff confirm they must talk in a loud voice to C1 because they are hard of hearing. LPA observations reveal C3 does have mouth open at times and does drool. C3 is nonverbal, and LPA was unable to interview; however, interviews with C1 and C2 reveal they have never witnessed any staff flick C3 in the mouth. Staff and administrators deny ever witnessing any staff member flicking or inappropriately touching C3 in the mouth area. C1 and C2 deny ever witnessing staff giving anyone the middle finger. They further explain that the staff are nice and helpful. Staff and administrators also deny ever witnessing any staff member giving clients the middle finger. Outside source interviews reveal that no clients in the home have reported to them any accounts of staff not interacting appropriately with clients.

Regarding the allegation that the staff threaten the resident. More specifically, S1 threatens to take Client #4(C4) cell phone and gifted earrings away if C4 moves out. The interview with the administrator indicates C4 does not own the cell phone; S1 owns the cell phone. Interviews with the administrator further explained that the earrings were a gift to C4. S1 denies making threats but does explain that the cell phone is theirs. Outside interviews reveal C4 does have a history of false accusations and attention-seeking behavior. Interviews with C1 and C2 reveal they have never witnessed threatening words to C4 by any staff member.

Due to lack of corroborating evidence, the finding regarding the above allegations were established to be unsubstantiated. This finding means there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Licensee/Administrator Simsuangco and a copy of this report along with Licensee Rights (LIC 9058 01/16) was provided to Licensee/Administrator Simsuangco. Signature on the for confirms receipt the reports were received.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025

LIC9099 (FAS) - (06/04)

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