374604321-10-2-2025-18-AS-RORN-DM9R7J-20251008124626

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604321
Report Date: 10/02/2025
Date Signed: 10/02/2025 12:14:31 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2022 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 18-AS-20220811094626

FACILITY NAME:	SANTA FAUSTINA ARF		FACILITY NUMBER:	374604321
ADMINISTRATOR:	BEALS, SUSAN		FACILITY TYPE:	735
ADDRESS:	227 BAVARIA DR		TELEPHONE:	(760) 806-9616
CITY:	VISTA	STATE: CA	ZIP CODE:	92083
CAPACITY:	6	CENSUS: 6	DATE:	10/02/2025
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	BEALS SUSAN		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff did not prevent resident from striking another person in the home with a weapon.

INVESTIGATION FINDINGS:

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On 10/02/2025, at approximately 8:00 AM, Licensing Program Analyst (LPA) Antonine Richard performed a follow-up unannounced complaint visit. LPA met with staff member Arlene Valenzuela. LPA Richard explained the purpose of this visit. At 8:20 am, the LPA was joined by the Licensee/Administrator, Susan Beals.
The investigation consisted of the following: On October 1, 2025, the Licensing Program Analyst (LPA) conducted interviews with Client #2-7 (C2-C7) and Staff Member #1 (S1). LPA interviewed Administrator (A1). The LPA also interviewed a representative from the San Diego Regional Center (SDRC). Additionally, the LPA obtained and reviewed several documents, including the Staff Roster and Resident Roster. A copy of Client #1's (C1) face sheet dated July 10/2020. Individual Program Plan (IPP) dated 12/21/2020. It was noted that Client #1 (C1) passed away on August 11, 2022. The Conclusion death certificate dated 08/31/22.

Report Continued LIC9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

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 18-AS-20220811094626

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SANTA FAUSTINA ARF	FACILITY NUMBER: 374604321
	VISIT DATE: 10/02/2025

NARRATIVE

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Allegation #1: Staff did not prevent the residents from striking another person in the home with a weapon.

The complaint alleged that staff members did not prevent a client from striking another client in the home with a weapon. On October 2, 2025, at approximately 8:10 AM, LPA Richard interviewed Staff Member 1 (S1), who denied the allegation and stated that it was unlikely a client at the facility would hit another person with a weapon.

Simultaneously, LPA interviewed the Administrator (A1), who also denied the allegation, explaining that there was an incident involving the passing of a client due to complications of end-stage renal disease.

At around 8:30 AM on the same day, LPA interviewed six Clients, #2 through #7 (C2-C7); all six denied ever hitting another client with a weapon or witnessing any client hit another with a weapon. At approximately 11:00 am, LPA also interviewed the SDRC, who stated there were no concerns regarding the passing of C1 at the facility on 08/11/2022.

Additionally, LPA reviewed facility notes dated from August 02, 2022, to August 7, 2022, indicating C1 was happy and went to the movies. On August 10, 2022, C1 attended a dialysis appointment and came home very happy. On October 02, 2025, LPA received the concluding document of C1's passing, as per the death certificate dated 08/31/22, through an email from the SDRC caseworker about C1's passing on 08/11/2022.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220811094626

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SANTA FAUSTINA ARF	FACILITY NUMBER: 374604321
	VISIT DATE: 10/02/2025

NARRATIVE

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Based on interviews, available evidence, observation, information received, and records reviewed, there was not sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is deemed unsubstantiated.

No deficiencies cited.

An exit interview was conducted. A copy of the report was provided to the Administrator Beals, Susan.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

LIC9099 (FAS) - (06/04)

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