374603431-8-5-2026-08-AS-SMAZ-DYDT4U-20260929142429

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603431
Report Date: 08/05/2026
Date Signed: 08/05/2026 10:29:35 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
07/28/2026 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20260728113233

FACILITY NAME:	ACTIVCARE AT ROLLING HILLS RANCH		FACILITY NUMBER:	374603431
ADMINISTRATOR:	BONGHABIH N. SHEY		FACILITY TYPE:	740
ADDRESS:	850 DUNCAN RANCH ROAD		TELEPHONE:	(619) 482-8000
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91914
CAPACITY:	80	CENSUS: 51	DATE:	08/05/2026
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Executive Director, Bee Bee Smith		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Staff hit resident

INVESTIGATION FINDINGS:

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On August 5, 2026, Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to open a complaint investigation and deliver findings regarding the above allegation. LPA met with Executive Director Bee Bee Smith and discussed the purpose of the visit and the contents of this report.

The Department's investigation included a facility tour, records review, and interviews with facility staff. An LIC 811, Confidential Names List, was provided to the facility to identify Resident 1 (R1) and Staff 1 (S1).

On July 28, 2026, Community Care Licensing (CCL) received a complaint alleging that Staff 1 (S1) physically abused Resident 1 (R1) by striking the resident.

During an interview, facility management stated that an internal investigation was conducted immediately following the allegation. The investigation included interviews with staff and residents. (continue at LIC9099C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2026

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-20260728113233

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: ACTIVCARE AT ROLLING HILLS RANCH	FACILITY NUMBER: 374603431
	VISIT DATE: 08/05/2026

NARRATIVE

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(continue from LIC9099)
Management reported that S1 denied striking R1 during the investigation.

Facility management stated that, prior to this incident, there had been no reported concerns that S1 had mistreated, abused, or otherwise disrespected residents. Records review indicated that S1 had been employed at the facility for approximately ten years. Personnel records reflected prior corrective actions related to job performance; however, none involved allegations of resident abuse or violations of resident personal rights.

Records review further indicated that R1 had resided at the facility for more than three years. During that time, there were no documented reports or allegations of similar abuse involving R1. Management reported that throughout the internal investigation, R1 consistently described the incident. Management further stated that R1 was alert and oriented to person, place, time, and circumstance and was considered a credible witness based on the consistency of the resident's statements.

Based on the evidence gathered during the internal investigation, facility management determined there was sufficient evidence to support the allegation that S1 struck R1 and terminated S1's employment. In addition, the facility conducted in-service training with staff regarding resident personal rights and reinforced that any form of resident abuse would not be tolerated and may result in disciplinary action, up to and including termination.

Based on interviews and records review, there is sufficient evidence to support that S1 struck R1. Therefore, the allegation is substantiated, meaning the preponderance of evidence standard has been met.

A deficiency was cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87468.1(a)(3), Personal Rights of Residents in All Facilities, as documented on the attached LIC 9099-D. A Plan of Correction (POC) was developed with Executive Director Bee Bee Smith to address staff training needs regarding resident personal rights, appropriate professional conduct, abuse prevention, and de-escalation techniques.

An exit interview was conducted with Program Director, Karen Pultorak . A copy of this report, LIC 9099-D, LIC 811 (Confidential Names List), and Licensee Appeal Rights (LIC 9058) were provided at the conclusion of the visit.

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2026

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20260728113233

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: ACTIVCARE AT ROLLING HILLS RANCH	FACILITY NUMBER: 374603431
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/05/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/07/2026 Section Cited CCR 87468.1(a)(3)	1 2 3 4 5 6 7	87468.1(a)(3) Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature… This requirement was not met as evidence by:	1 2 3 4 5 6 7	ED agrees to conduct staff Training on Personal Rights with emphasis on respect and treating residents with dignity and respect. POC Due Date: 9-5-2026
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee failed to ensure that Resident (R1) was treated with dignity and respect at all times. This poses a potential risk to the health, safety, and emotional well-being of one (1) if two (52) residents in care.	8 9 10 11 12 13 14	Amended to Type A violation
	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.

SUPERVISOR'S NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2026

LIC9099 (FAS) - (06/04)

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