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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603004
Report Date: 05/07/2025
Date Signed: 05/07/2025 02:59:47 PM

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
09/25/2024 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20240925163434
FACILITY NAME:SUBLIME LIVINGFACILITY NUMBER:
374603004
ADMINISTRATOR:LUIS DE LA ROSAFACILITY TYPE:
735
ADDRESS:1210 SANGAMON AVETELEPHONE:
(619) 303-8426
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:6CENSUS: 6DATE:
05/07/2025
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Monica McDade, Program ManagerTIME COMPLETED:
11:57 AM
ALLEGATION(S):
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9
Staff neglect resulted in client's physical needs not being met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close a complaint investigation regarding the above-mentioned allegation. LPA identified herself and met with Monica McDade, Program Manager.

It was alleged that staff neglect resulted in client's physical needs not being met. Interviews with clients revealed that the staff have not hit them or hurt them. Interviews revealed they have not seen any staff hit any of the clients. Interviews with client 1 (C1) revealed the staff only help them and that they did not remember what happened or how they got the bruise. Interviews with staff revealed around approximately 2am on 09/21/2024 C1 was in their room sleeping when staff heard a thump sound.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
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 2
Control Number 08-AS-20240925163434
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: SUBLIME LIVING
FACILITY NUMBER: 374603004
VISIT DATE: 05/07/2025
NARRATIVE
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Interviews revealed that the overnight staff went to check and found that C1 had fallen out of their bed while sleeping. Interviews with staff revealed they assessed C1 and observed that they started to have a small swell under their right eye with a bit of discoloration. Interviews revealed the client did not complain of any pain or discomfort. Interviews revealed that C1 has a history of seizures and they think C1 had a seizure and fell out the bed. Interviews with outside sources revealed they did not have any concerns of staff neglecting or not meeting C1s needs.

The allegation of staff neglect resulted in client's physical needs not being met is unsubstantiated.

An exit interview was conducted with Monica McDade, Program Administrator. A copy of this report and Licensee Appeal rights (LIC 9058 03/22) were provided at the end of the visit.




SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2