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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603625
Report Date: 10/16/2025
Date Signed: 10/16/2025 03:52:21 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
10/07/2025 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20251007092109
FACILITY NAME:STELLAR CAREFACILITY NUMBER:
374603625
ADMINISTRATOR:BRANDON CHOFACILITY TYPE:
740
ADDRESS:4518 54TH STREETTELEPHONE:
(619) 287-2920
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:150CENSUS: 104DATE:
10/16/2025
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Assisted Living Director Annelie DamascoTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Licensee pursued unlawful eviction of resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Assisted Living Director Annelie Damasco.

The Complainant alleged that Licensee pursued unlawful eviction of Resident #1 (R1). [See LIC 811 Confidential Names List for a description of R1.] CCLD’s investigation involved multiple unannounced facility tours/welfare checks and interviews of R1 and their relevant housemates/peers, facility staff, and outside sources. The Department also reviewed pertinent administrative, care, and medical records and E-mail correspondence.

On 10/03/2025, Licensee served R1 with a 30-day eviction notice letter. The basis/reason for the eviction was R1’s breaking of facility house rules, to include “verbal or physical abuse towards other residents,” “use of profanity or other offensive language,” and “antisocial behavior.” [CONTINUED ON LIC 9099]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
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 5
Control Number 08-AS-20251007092109
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: STELLAR CARE
FACILITY NUMBER: 374603625
VISIT DATE: 10/16/2025
NARRATIVE
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[CONTINUED FROM LIC 9099] The Complainant contested the underlying basis for the eviction, saying R1 tended to be the victim rather than the aggressor during their interpersonal conflicts with peers. They also claimed the eviction reason was not well described in the letter.

Based on R1’s latest LIC602 Physician’s Report and other medical records: Although R1 was diagnosed with Dementia, R1 scored 28-29 points out of 30 on their last Mini-Mental State Exam (MMSE) cognitive test. R1’s doctor also wrote that R1 did not have sundowning behaviors, and that R1 was “able to follow instructions” and “able to communicate their needs.” In their interview, R1 displayed to LPA that they were oriented to self, others, place, and date, and were able to remember past events. Per a multi-year review of Licensee’s prior LIC624 and SOC341 incident reports (all of which were submitted to CCLD prior to this complaint), and corroborated by interviews of both staff and multiple other residents: R1 had previously harassed and/or antagonized multiple peers, requiring staff intervention/redirection. R1 sometimes yelled/cursed at peers. R1 sometimes pushed/hit peers (all without injury). R1 was the initiator during most of these interpersonal conflicts. R1’s pattern of rudeness had worsened over time, rather than improving. As of the commencement of CCLD’s investigation, R1’s antisocial behavior towards at least one peer was ongoing.

CCLD concluded that Licensee’s stated basis for evicting R1 was thus true and valid. However, the eviction notice letter which Licensee served on 10/03/2025 did not contain “specific facts” relied upon for eviction, to include all relevant dates, “place[s], witnesses, and circumstances,” as explicitly required by CCR 87224(d). The letter also did not specify the “effective date” that the 30-day notice period would expire, as explicitly required by CCR 87224(d)(1)(A). Said eviction notice therefore did not meet all legal requirements, and was thus unlawful, but only because of technical issues with the letter itself.

Based on records and interviews, a preponderance of evidence exists to show that Licensee pursued unlawful eviction of a resident. The allegation is therefore Substantiated, and one (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). LPA also issued two (2) Technical Violations (TV) related to incident reporting requirements and eviction notice letter formatting. A Plan of Correction was jointly developed with the Licensee.

An exit interview was conducted with Assisted Living Director Annelie Damasco, to whom a copy of this report, the LIC 9099-D page, the LIC9102-TV pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20251007092109
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: STELLAR CARE
FACILITY NUMBER: 374603625
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2025
Section Cited
CCR
87224(d)
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87224 Eviction Procedures: “(d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons.” This requirement was not met, as evidenced by:
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On 10/13/2025, Licensee notified R1’s representative in writing that the 10/03/2025 eviction notice letter was rescinded, pending corrections. The Plan of Correction was thus Satisfied. [As noted earlier in this report, CCLD determined that underlying reason for the eviction was valid. On 10/15/2025, Licensee issued a new 30-day eviction letter for R1, which now included the required “specific facts” and had an updated “effective date.”]
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Licensee issued 1 of 104 residents (R1) a notice to quit (i.e., a written eviction letter), but the notice did not include specific facts to permit determination of the date, place, witnesses, and circumstances concerning the reason(s) for eviction. This posted a potential personal rights risk to persons in care.
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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: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
10/07/2025 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20251007092109

FACILITY NAME:STELLAR CAREFACILITY NUMBER:
374603625
ADMINISTRATOR:BRANDON CHOFACILITY TYPE:
740
ADDRESS:4518 54TH STREETTELEPHONE:
(619) 287-2920
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:150CENSUS: 104DATE:
10/16/2025
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Assisted Living Director Annelie DamascoTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Licensee’s staff did not uphold resident dignity.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver finding(s) regarding the above prior complaint allegation(s). LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Assisted Living Director Annelie Damasco.

The Complainant alleged that Licensee’s staff did not uphold resident dignity. CCLD’s investigation involved multiple unannounced facility tours/welfare checks and interviews of R1 and their relevant housemates/peers, facility staff, and outside sources. The Department also reviewed pertinent administrative, care, and medical records.


[CONTINUED ON LIC 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20251007092109
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: STELLAR CARE
FACILITY NUMBER: 374603625
VISIT DATE: 10/16/2025
NARRATIVE
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[CONTINUED FROM LIC 9099-A]

The Complainant claimed within the last few months there was a day when Resident #1 (R1) was in a common area activity room with fellow residents. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] Facility Staff #1 (S1) overheard R1 speak negatively about another resident, in R1’s native language. S1 then verbally corrected / told R1 to stop, loud enough that other residents present could hear it (instead of speaking to R1 privately). This caused R1 to feel humiliated/embarrassed, to the point that R1 left the activity to go to their own room.

The Complainant did not have direct knowledge of the matter but instead relied on the statement of R1 to them. There were discrepancies between what R1 reported to the Complainant, verses what R1 reported to LPA, about the incident.

CCLD’s investigation showed: On the date in question, S1 overheard R1 speak negatively about Resident #2 (R2) to Resident #3 (R3). (S1, R1, R2, and R3 each spoke the same foreign language.) S1 told R1 to stop talking about other people. There was no indication that S1’s choice of words was unprofessional, or that S1 raised their voice or yelled.

In their own interview with LPA, R1 denied feeling embarrassment/shame from the interaction, instead saying S1 misread the situation and did not even know what they were talking about. R1 said they continued in the same activity program until it was completed, and after that they went back to their room. R1 told LPA they did not have any grievances related to facility staff hurting their feelings or dignity.

Based on records and interviews, a preponderance of evidence does not exist to show that Licensee’s staff did not uphold resident dignity. The allegation is therefore Unsubstantiated, and no deficiency was cited for it.

An exit interview was conducted with Assisted Living Director Annelie Damasco, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5