374603136-9-26-2025-08-AS-LTEZ-DM22MR-20250930173133

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603136
Report Date: 09/26/2025
Date Signed: 09/26/2025 04:08:04 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
06/10/2025 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20250610103152

FACILITY NAME:	CORONADO RETIREMENT VILLAGE		FACILITY NUMBER:	374603136
ADMINISTRATOR:	ELIZABETH REYES		FACILITY TYPE:	740
ADDRESS:	299 PROSPECT PLACE		TELEPHONE:	(619) 437-1777
CITY:	CORONADO	STATE: CA	ZIP CODE:	92118
CAPACITY:	120	CENSUS: 79	DATE:	09/26/2025
		UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Wellness Director, Camille Nero		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff did not meet resident's care needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit regarding the above-mentioned allegation(s). LPA met with Wellness Director, Camille Nero.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged the facility staff did not meet resident's care needs regarding Resident #1 (R1). It was reported that on May 5, 2025, R1 fell at the facility, sustained injuries, and did not report the incident to facility staff. R1’s Physician’s Report dated July 18, 2024, indicated R1 was ambulatory and independent with bathing, dressing/grooming, feeding, toileting, medication management, laundry and able to leave the facility unassisted. On May 7, 2025, R1 was observed by staff with a bump the size of a quarter on R1’s forehead and a black eye. An outside source reported staff never saw the injury when it occurred due to not properly checking on R1. The outside source also indicated the facility staff initial their names on the residents’ "check in" log for the entire day without checking on R1. Continued on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

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-20250610103152

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: CORONADO RETIREMENT VILLAGE	FACILITY NUMBER: 374603136
	VISIT DATE: 09/26/2025

NARRATIVE

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Staff interviews confirmed they conducted status checks on R1. However, R1 was independent and did not like staff entering their room. Staff explained they would stand at the door and ask R1 is they were okay and/or needed anything. Staff stated R1 would respond no, and they would initial the check-in log and depart. Staff added R1 usually was in bed or sitting in their chair reading, and they would call out to R1 to check on them. R1 confirmed they did not like staff checking in on them and would refuse services. R1 also stated they tried to hide their injuries from staff by hiding their face during their check-ins and leaving the facility without stopping by the front desk to check out. R1 continued to report to staff they were fine, when checked on. A review of facility records verified the room checks conducted by staff were also supported by room check logs initialed by staff. The facility’s check-in log sheet for May 11, 2025, reflected R1 was checked on and staff confirmed R1 did not complain of pain or show signs of symptoms. R1 admitted they were able to hide their injuries and avoid staff.

During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Wellness Director, Camille Nero whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

LIC9099 (FAS) - (06/04)

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