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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604103
Report Date: 06/26/2024
Date Signed: 06/26/2024 02:19:12 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
10/06/2020 and conducted by Evaluator Becky Kennedy
COMPLAINT CONTROL NUMBER: 08-AS-20201006083903
FACILITY NAME:SIENNA AT OTAY RANCH SENIOR LIVINGFACILITY NUMBER:
374604103
ADMINISTRATOR:MENDEZ, RUBY GOMEZFACILITY TYPE:
740
ADDRESS:1290 SANTA ROSA DRTELEPHONE:
(619) 550-4521
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:0CENSUS: DATE:
06/26/2024
UNANNOUNCEDTIME BEGAN:
02:12 PM
MET WITH:TIME COMPLETED:
02:13 PM
ALLEGATION(S):
1
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9
Staff are restraining residents.
INVESTIGATION FINDINGS:
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2
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5
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13
Licensing Program Analyst Becky Kennedy concluded the investigation which began on 10/14/2020.
The investigation into the above allegations consisted of interviews with internal sources, a review of internal documents, and a tour of the facility.
It was alleged that the facility staff restrained residents to manager difficult behavior. Interviews revealed that some of the residents displayed problematic behaviors that challenged that staff caring for them, no information was revealed to confirm this allegation.
Based on the investigation, the allegation that the facility staff are restraining residents is UNSUBSTANTIATED, meaning that there is not a preponderance of the evidence proving that the alleged violation occurred.
A copy of this report along with the Applicant/Licensee Rights (LIC9058 01/16) was mailed to Licensee’s last known mailing address via USPS mail.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky KennedyTELEPHONE: 619-672-5843
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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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