374602712-5-7-2026-18-AS-RORN-DU8P9T-20260519110740

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602712
Report Date: 05/07/2026
Date Signed: 05/07/2026 01:48:37 PM

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
04/03/2024 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 18-AS-20240403234637

FACILITY NAME:	ANNE'S PLACE IV		FACILITY NUMBER:	374602712
ADMINISTRATOR:	DEARME DOVERTE		FACILITY TYPE:	740
ADDRESS:	2870 WANEK ROAD		TELEPHONE:	(760) 233-5878
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92027
CAPACITY:	10	CENSUS: 9	DATE:	05/07/2026
		UNANNOUNCED	TIME BEGAN:	10:33 AM
MET WITH:	DEARME DOVERTE		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff is financially abusing a resident while in care.

INVESTIGATION FINDINGS:

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On May 7, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced follow-up investigation regarding a complaint. During the visit, the LPA met with the Administrator, Dearme Doverte, and explained the purpose of the visit.
The investigation involved collecting records and touring the facility. On this date, the Department obtained various documents, including the Personnel Report (LIC 500) dated March 18, 2026, and the Resident Roster also dated March 18, 2026. The Department reviewed and collected documentation for resident #1, which included the Face Sheet dated February 24, 2022; Admission Agreement dated February 24, 2022; Physician's Report dated February 14, 2024; Appraisal Needs and Services Plan dated June 6, 2024; Medical Notice of Action dated December 1, 2023; Medical Action Approval dated July 1, 2024; Assisted Living Waiver dated August 2, 2024; and the Death Report dated November 15, 2024. The Department interviewed the Licensee, the Administrator, three staff members (S1-S3), and three other residents (R2-R4). The LPA was unable to interview resident #1 (R1), as R1 had passed away on November 11, 2024.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

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 3

Control Number 18-AS-20240403234637

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 IV	FACILITY NUMBER: 374602712
	VISIT DATE: 05/07/2026

NARRATIVE

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Allegation #1: Staff financially abusing a resident while in care.

The complaint alleged that the licensee sought to become the resident's representative for financial matters to oversee the Medi-Cal process. On May 7, 2026, the department interviewed the licensee, who denied the allegation, stating that the resident's responsible party (RP) had asked the facility to transport the resident (R1) to a Medi-Cal appointment because the RP lived outside San Diego.

During the same interview, the department interviewed the Administrator (A1), who also denied the allegation. A1 explained that R1's Medi-Cal was set to expire soon and needed to be renewed; if it expired, the Assisted Living Waiver (ALW) would remove R1 from the program. A1 stated that, since the RP, who resides outside San Diego, requested the facility's assistance, it was the facility's responsibility to assist R1 with Medi-Cal appointments to resolve the issue. A1 also mentioned that the Medi-Cal program was ultimately renewed through the Care Coordinator Agency Libertana on July 1, 2024.

Additionally, on May 7, 2026, the department interviewed three staff members (S1-S3), all of whom denied the allegation. It indicated that they care for the residents but lack knowledge of their finances. Three residents (R2-R4) were also interviewed; they expressed satisfaction with their living situation and reported no issues regarding their Medi-Cal or financial matters.

Report Continued on LIC9099C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20240403234637

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 IV	FACILITY NUMBER: 374602712
	VISIT DATE: 05/07/2026

NARRATIVE

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The department also interviewed the responsible party (RP), who denied the allegation and confirmed that the facility was a tremendous help to R1. The RP, residing outside San Diego, noted the challenges of being present all the time. The RP stated that there was no financial abuse and that they had specifically asked the facility to assist in taking R1 to the appointment and to provide any necessary assistance. The department records review of ALW and Medi-Cal on May 7, 2026, confirmed that R1 was a program member.

Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited.

An exit interview was conducted. A copy of this report was provided to the Administrator, Dearme Doverte

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC9099 (FAS) - (06/04)

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