374603584-12-30-2025-08-AS-LTEZ-DQR2H9-20260127162421

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603584
Report Date: 12/30/2025
Date Signed: 12/30/2025 02:43:24 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
01/13/2025 and conducted by Evaluator Janet Ngallo

COMPLAINT CONTROL NUMBER: 08-AS-20250113162207

FACILITY NAME:	ACTIVCARE AT MISSION BAY		FACILITY NUMBER:	374603584
ADMINISTRATOR:	DESTEFANI, DAWN		FACILITY TYPE:	740
ADDRESS:	2440 GRAND AVENUE		TELEPHONE:	(858) 270-8000
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92109
CAPACITY:	60	CENSUS: 55	DATE:	12/30/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Be Le, Buisiness Office Manager, Jeremy Przybylek, Marketing Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Licensee did not take steps to prevent the spread of a communicable disease.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Janet Ngallo conducted an unannounced subsequent visit to deliver findings regarding the above-mentioned complaint allegation. LPA introduced themselves and disclosed the purpose of the visit and elements of the complaint to Business Office Manager Be Le and Marketing Director Jeremy Przybylek.

On January 13th, 2025, it was alleged that facility did not take steps to prevent the spread of a communicable disease. The department's investigation consisted of unannounced facility visits, LPA observations, interviews with outside sources, facility staff, and records review.

(Cont. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

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-20250113162207

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 MISSION BAY	FACILITY NUMBER: 374603584
	VISIT DATE: 12/30/2025

NARRATIVE

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(Cont. from LIC 9099)

Regarding the above-mentioned allegation, staff members and outside sources were interviewed. LPA attempted to interview several residents, however due to their major neurocognitive disorders, they were not considered reliable historians for the purpose of this investigation. Resident Power of Attorney(POA) interviews were conducted as all residents in the facility have some diagnosis of major neurocognitive disorder and reside in a secured memory care unit. Staff interviews did not corroborate the allegation, as staff consistently reported that infection control protocols were followed during the time of the outbreak, including the use of PPE, multiple in-service trainings on identifying and managing scabies, proper use of gowns and gloves, and handling contaminated clothing.

During the interview with the Executive Director(ED), it was stated that the same 3–4 residents who were initially infected experienced recurring cases of scabies. However, all other residents who contracted the disease were treated successfully and did not experience reinfection. The ED stated the facility consulted multiple physicians and specialists, followed public health guidance, and repeatedly treated and monitored affected residents.

Outside source interviews (Resident 1 and 2's POA's) did not corroborate the allegation, as Outside Source 1 and Outside Source 2 (OS1 and OS2) consistently stated that the facility had consistent communication during the outbreak and that they had no concerns. Outside sources consistently stated that the outbreak was addressed professionally and that the facility did an excellent job at monitoring and communicating the status of the outbreak at the time.

(Cont. on LIC 9099-C pg. 2)

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20250113162207

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 MISSION BAY	FACILITY NUMBER: 374603584
	VISIT DATE: 12/30/2025

NARRATIVE

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(Cont. from LIC 9099-C pg. 1)

Outside source 3 (OS3)(Previous resident 3's POA) stated that the facility did attempt to call about the rash on their resident and that once OS3 agreed to use the facility’s dermatologist, the treatment finally worked and OS3 was satisfied with the care. While OS3 felt communication could have been clearer, OS3’s own account shows the facility tried to notify them and provided effective medical support.

Review of the facility records did not corroborate the allegation as documentation showed that staff received in-service training on contact precautions, scabies, and PPE station maintenance supported by email correspondence and caregiver sign-in sheets. Progress notes for R1, R2, R3, and R4 reflected multiple instances of rash-related medication administration and POA notification, with additional records confirming that residents received physician-prescribed treatment and were evaluated by a dermatology specialist who ordered multiple medication treatments. Email correspondence from the Department of Public Health revealed that the facility reported the scabies outbreak and was provided guidance materials for prevention and control. The facility’s infection control plan additionally outlined comprehensive precautionary measures consistent with the practices staff described during interviews.

During the facility visit, the LPA observed residents well-groomed and clean. LPA observed
storage areas which contained adequate and appropriate Personal Protective Equipment (PPE), including masks, gloves, gowns, and test kits.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Marketing Director Jeremy Przybylek, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided and their signature on this report confirms receipt of the Licensee Rights.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

LIC9099 (FAS) - (06/04)

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