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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604178
Report Date: 04/07/2026
Date Signed: 04/07/2026 11:56:00 AM

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
02/05/2026 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20260205091440
FACILITY NAME:CASA DE MAYAFACILITY NUMBER:
374604178
ADMINISTRATOR:GONZALEZ, JOSE A.FACILITY TYPE:
735
ADDRESS:9643 BOTE CTTELEPHONE:
(619) 201-0676
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:4CENSUS: 4DATE:
04/07/2026
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Olga Gonzalez, StaffTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff verbally abuse resident
Staff were inappropriately banging on resident 's door
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Tiffany Holmes conducted a visit to commence a complaint investigation into the above identified allegation. LPA was granted entry into the facility by Olga Gonzalez, Staff, to whom LPA disclosed the purpose of the visit. Community Care Licensing (CCL) has investigated the above-listed complaint allegations.

The investigation consisted of interviews with outside sources, facility staff and clients. It was alleged that the staff verbally abuse resident and staff were inappropriately banging on resident 's door. Interviews with outside sources revealed that they heard someone knocking on the clients door but did not hear any words that were said. Interviews with staff denied the allegations of verbally abusing the client and inappropriately banging on the clients door. Interviews also revealed that Client 1 (C1) stated they don't have a problem with the other clients using the bathroom in their room since they only have another one in the hallway. Interviews revealed the client had to use the bathroom twice and within a span of 10-15 minutes so C1 got irritated because they were on an important call. Interviews revealed C1 stated there wasn't aggressive banging on their door just a lot of knocking and that the staff talk nicely to them. Interviews revealed the staff speak to clients with respect and does not abuse them.

The allegations may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. The allegations are unsubstantiated.

An exit interview was conducted with Olga Gonzalez, Staff, and a copy of this report, and Licensee/Appeal Rights (LIC9058) were provided at the conclusion of the visit, their signature on this report acknowledges receipt of copies of the reports and the rights.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026
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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