374602822-4-15-2026-08-AS-SJAB-DTDVXX-20260422165015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602822
Report Date: 04/13/2026
Date Signed: 04/15/2026 12:41:00 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
02/12/2025 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20250212160007

FACILITY NAME:	RODRIGUEZ RESIDENTIAL CARE		FACILITY NUMBER:	374602822
ADMINISTRATOR:	CYNTHIA RODRIGUEZ-REINA		FACILITY TYPE:	735
ADDRESS:	2914 30TH STREET		TELEPHONE:	(619) 282-3921
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92104
CAPACITY:	12	CENSUS: 9	DATE:	04/13/2026
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Cynthia Rodriguez-Reina Administrator		TIME COMPLETED:	11:13 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff mishandled a client's medication while in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced themselves and disclosed the purpose of the visit to Cynthia Rodriguez-Reina Administrator

The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review.

On 2/12/25, it was alleged that staff mishandled a client's medication.Outside Source 1 (OS1) stated that during a medication audit conducted on 02/12/25, OS1 identified that one resident did not have the required medication available for the month. OS1 reported that later in the day, S1 informed OS1 that the missing medication had been mistakenly discarded.

(Continued on LIC9099C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

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 08-AS-20250212160007

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: RODRIGUEZ RESIDENTIAL CARE	FACILITY NUMBER: 374602822
	VISIT DATE: 04/13/2026

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

(Continued from LIC9099)

Staff 1 (S1) was interviewed and reported that the medication for Client 1 (C1) was mistakenly discarded. S1 stated that during the medication pass, S1 was simultaneously destroying discontinued medication, administering medication, and accepting newly delivered medication. S1 explained that they normally do not multitask while handling medications. S1 reported that a resident had recently requested a medication, and the pharmacy filled the order. S1 stated that while she was in the process of destroying the discontinued medication, the newly delivered medication was mistakenly included and destroyed in error. When the resident later asked for the medication, S1 was unable to locate it and realized it had been destroyed. S1 further reported that when the facility contacted the prescribing physician to request a replacement, the
Physician authorized the refill the medication and was delivered the same day.

LPA Domingo conducted an observation of the medication storage area and reviewed the facility’s medication charts. The medication area was organized and free of clutter. Each medication basket was clearly labeled with the corresponding resident’s name. Medications stored in each basket matched the residents’ current medication lists, and no discrepancies or missing medications were noted at the time of the visit.

Based on relevant interviews and records review, the preponderance of evidence has been met that the alleged violation occurred and are therefore substantiated. Deficiencies are cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Cynthia Rodriguez-Reina Administrator to whom a copy of this report, the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20250212160007

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: RODRIGUEZ RESIDENTIAL CARE	FACILITY NUMBER: 374602822
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/14/2026 Section Cited CCR 80075(b)(5)(B)	1 2 3 4 5 6 7	Health Related Services (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. (5)(B) Once ordered by the physician, the medication is given according to the physician's directions. This requirement was not met as evidenced by;	1 2 3 4 5 6 7	The Administrator put in place a new method of medication delivery and destruction. The administrator will only conduct one task at a time and will have another staff present during the time of delivery and destruction so avoid any errors.
	8 9 10 11 12 13 14	Based on observations, interviews, and records reviewed, the licensee did not assist in medication administration for one of twelve persons in care, which posed a potential Health and Safety risk to the person 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.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3