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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603237
Report Date: 06/04/2026
Date Signed: 06/04/2026 10:44:03 AM

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
07/25/2023 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20230725091856
FACILITY NAME:ROXIES ELDERLY HOMES IIFACILITY NUMBER:
374603237
ADMINISTRATOR:TERESITA ROXASFACILITY TYPE:
740
ADDRESS:4560 VINYARD STREETTELEPHONE:
(442) 266-2939
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:6CENSUS: 6DATE:
06/04/2026
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Teresita Roxas, AdministratorTIME COMPLETED:
10:40 AM
ALLEGATION(S):
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7
8
9
Licensee did not provide activities
Licensee did not provide hygiene items
Licensee did not provide reasonable accommodations
INVESTIGATION FINDINGS:
1
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5
6
7
8
9
10
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13
Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to close out a complaint on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Teresita Roxas, Administrator to discuss the purpose of the visit.

LPA Borruda conducted a tour of the facility, and conducted interviews on 08/02/2023. LPA Holmes conducted interviews with residents, staff and outside sources. It was alleged that the licensee did not provide activities, the licensee did not provide hygiene items and that the licensee did not provide reasonable accommodations. Interviews revealed that the residents just sit around the facility and watch television or read the news paper. Prior LPA observations revealed there were no activities out for the residents use and interviews with the residents revealed there is nothing for them to do but sit around and or watch television. Interviews and observations also revealed that the residents did not have paper towels in the bathrooms and that they would wash their hands and dry them with toilet paper. Interviews also revealed that the facility did not provide reasonable accomodations by running the air condioner instead of fans. LPA observations revealed several fans around the facility and in the resident rooms. The thermostat read 81 prior to noon on the day they were there and then 84 degrees by 1pm. LPA Holmes observation on todays visit is that the facility was cool and the doors were open to let the air in.

Based on the evidence obtained from interviews, the complaint allegations are substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met.

A deficiency is cited per Title 22 California Code of Regulation on the 9099 D page. An exit interview was conducted with Teresita Roxas, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
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 4
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
07/25/2023 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20230725091856

FACILITY NAME:ROXIES ELDERLY HOMES IIFACILITY NUMBER:
374603237
ADMINISTRATOR:TERESITA ROXASFACILITY TYPE:
740
ADDRESS:4560 VINYARD STREETTELEPHONE:
(442) 266-2939
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:6CENSUS: 6DATE:
06/04/2026
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Teresita Roxas, AdministratorTIME COMPLETED:
10:40 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Meals did not meet residents dietary needs
Staff did not meet residents care needs
Resident was not able to attend medical appointments
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to close out a complaint on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Teresita Roxas, Administrator to discuss the purpose of the visit.

LPA Borruda conducted a tour of the facility, and conducted interviews on 08/02/2023. LPA Holmes also conducted interviews with staff, residents and outside sources. It was alleged that the meals did not meet residents dietary needs, staff did not meet residents care needs and the resident was not able to attend medical appointments. Interviews revealed that the meals are given and there is plenty of food but it may not always be to their liking. The meals usually consist of a meat, vegatable and a starch. interviews revealed that if a resident is on a special diet they follow the diet for the resident and to the doctors orders. The resident care needs are met by staff providing meals and assisting residents with what they need assistance with. Interviews revealed that the residents are able to have appointments and if they are by zoom they find a place for the residents to have the video calls. Interviews revealed the staff denied not letting the resident have their appointments. Interviews revealed the staff would asssist the resident and set everything up for them for their doctors visit.

Based on the evidence obtained from interviews, the complaint allegations are unsubstantiated. The allegations may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Teresita Roxas, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20230725091856
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: ROXIES ELDERLY HOMES II
FACILITY NUMBER: 374603237
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2026
Section Cited
CCR
87219(a)(2)(3)
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7
Planned Activities
(a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include:(2) Daily living skills/activities which foster and maintain independent functioning.

(3) Cognitive and mental stimulation activities such as reading, writing, movies, crossword puzzles, board and card games, and using the computer.

This requirement was not met as evidence by:
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Licensee will purchase games and puzzles for the residents use. POC due by 06/10/2026. Licensee will send a picture to LPA Holmes of reciept
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Based on observations and interviews, the licensee failed to provide activities for 6 out of 6 residents (R1-R6)

This poses a potential health and safety risk to residents in care.
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Type B
06/10/2026
Section Cited
CCR
87307(3)(D)
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Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of:(D) Hygiene items of general use such as soap and toilet paper.
This requirement was not met as evidence by:
1
2
3
4
5
6
7
Licensee will make sure that there are extra toilet paper and paper towels at the facility at all times. LPA Holmes observed several paper towel rolls at the facility during the visit. Licensee will purchase more paper towels to have extra by POC date of 06/10/2026. Licensee will send a picture to LPA Holmes of reciept
8
9
10
11
12
13
14
Based on observations and interviews, the licensee failed to provide paper towels for 6 out of 6 residents (R1-R6).

This poses a potential health and safety risk to residents in care.
8
9
10
11
12
13
14
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: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20230725091856
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: ROXIES ELDERLY HOMES II
FACILITY NUMBER: 374603237
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/29/2026
Section Cited
CCR
87468.1(a)(2)
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7
87468.1 Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement was not met as evidence by:
1
2
3
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7
Licensee will turn the fans on early in the am to keep the facility cool. There AC at the facility is ran when it is really hot Licensee will go over with staff when to use ac and the fans. Licensee will send over written documentation that shows she spoke with staff about this. POC due 6/10/2026
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Based on records and interviews the licensee did not provide healfull and comfortable accomodations in 1 of 6 persons in care(R1-R6) which posed a potential Personal Rights risk to persons in care

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7
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7
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7
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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: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4