374603596-9-26-2025-08-AS-SJAB-DQBPV4-20260114103827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603596
Report Date: 09/26/2025
Date Signed: 09/26/2025 03:15:47 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
08/12/2025 and conducted by Evaluator Angelica Boyles

COMPLAINT CONTROL NUMBER: 08-AS-20250812124633

FACILITY NAME:	PEOPLE'S CARE JOHNSON LAKE		FACILITY NUMBER:	374603596
ADMINISTRATOR:	SILVIA DAVALOS		FACILITY TYPE:	735
ADDRESS:	11691 JOHNSON LAKE DR		TELEPHONE:	(619) 390-1380
CITY:	LAKESIDE	STATE: CA	ZIP CODE:	92040
CAPACITY:	4	CENSUS: 4	DATE:	09/26/2025
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Priscila Galindo - Caregiver		TIME COMPLETED:	03:14 PM

ALLEGATION(S):

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Staff pushed a client in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to deliver investigative findings regarding the above mentioned allegation. LPA identified herself, explained the purpose of the visit and nature of the complaint to caregiver Priscila Galindo.

On August 12, 2025 the Department received this complaint which alleged on August 7, 2025 Staff #1 (S1) pushed Client #1 (C1) which was witnessed by Staff #2 (S2). [See LIC811 Confidential Name List for a description of select person identifiers used in this report]. The Department’s investigation included interviews with residents, staff and an outside sources.

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
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-20250812124633

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: PEOPLE'S CARE JOHNSON LAKE	FACILITY NUMBER: 374603596
	VISIT DATE: 09/26/2025

NARRATIVE

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(Continued from LIC9099)

Records reviewed revealed that the facility submitted a Special Incident Report and Report of Suspected Dependent Adult/Elder Abuse form to the Department once S2 reported the alleged incident. Per these reports no injuries were observed on C1.

LPA attempted to interview C1, however, C1 is non-verbal and unable to answer questions. Interviews with other clients in care revealed they have never been pushed or injured by staff. Clients also reported not being aware of the alleged incident. Interviews with other staff did not report witnessing the alleged incident, nor did they report ever witnessing concerning treatment towards clients by S1 or any other staff. There were no witnesses to corroborate the incident as alleged by S2. In an interview with S1, they denied pushing C1.

An interview with an outside source familiar with the facility did not report any concerns regarding staff pushing or mistreating clients in care.

During unannounced facility visits, LPA did not observe staff mistreating clients in care.

The Department has investigated the above-mentioned allegation. Based upon the information obtained during this investigation, although the allegation may have occurred or be valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur; therefore, the allegation are unsubstantiated.

And exit interview was conducted with Priscila Galindo, to whom a copy of this report and the Licensee’s Rights (LIC9058 01/16) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
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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