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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604385
Report Date: 05/12/2026
Date Signed: 05/12/2026 01:37:17 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
09/19/2024 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20240919094931
FACILITY NAME:MAJELLA ASSISTED LIVING OF SAN MARCOSFACILITY NUMBER:
374604385
ADMINISTRATOR:MORRISON, JIMFACILITY TYPE:
740
ADDRESS:558 SMILAX RD.TELEPHONE:
(760) 734-5786
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:11CENSUS: 7DATE:
05/12/2026
UNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:JIM MORRISONTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff gave resident unauthorized medications.
INVESTIGATION FINDINGS:
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On May 12, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA), Antonine Richard, conducted an unannounced follow-up complaint visit. The LPA met with the Administrator (A1), Jim Morrison, and explained the purpose of the visit.

The investigation included collecting records and touring the facility. On May 12, 2026, the Department obtained various documents, including the Personnel Report LIC 500 (dated 05/11/26) and the Resident Roster (dated 05/11/26). The Department reviewed and collected documents for resident R1, including the Admission Agreement, the physician's Report dated 09/26/24, the Appraisal Needs and Services Plan dated 09/23/24, the Medication Administration Records (MARs) dated 08/14/2024, and the Facility notes dated 09/13/2024. The Department also obtained hospital discharge documents dated 09/23/2024. The Department was unable to interview R1 because R1 passed away on 10/14/24.

Report Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026
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 3
Control Number 18-AS-20240919094931
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: MAJELLA ASSISTED LIVING OF SAN MARCOS
FACILITY NUMBER: 374604385
VISIT DATE: 05/12/2026
NARRATIVE
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Allegation: Staff gave resident unauthorized medications.

The complaint alleged that the residents were given Melatonin and Lorazepam, 1mg of medication that was not prescribed to the residents. On May 12, 2026, the department conducted an interview with the Administrator (A1), who denied the allegations. A1 reported that the residents (R1) had been displaying increased behavioral issues, including yelling, screaming, and removing their wound dressings, for two weeks. A1 also mentioned that they contacted the physician to inform them about R1’s sleep difficulties. As a result, the physician, the nurse, and the provider issued an order for Melatonin.

On September 12, 2024, at approximately 8:25 PM, the staff reached out to A1 to express concerns about R1's behavior. Despite implementing various non-medication interventions, R1's behavior did not improve. A1 stated that they called the physician again to explain the ongoing situation, and the physician agreed to instruct the staff to administer a second dose of Melatonin to R1.

The following day, on September 13, 2024, R1's behavior had not changed, prompting the facility to contact Emergency Medical Services (EMS), which transported R1 to the hospital.

On May 12, 2026, the department interviewed three staff members (S1-S3), all of whom stated they assisted residents only with medications prescribed by the doctor. If medication was not prescribed, they could not administer it to residents.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20240919094931
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: MAJELLA ASSISTED LIVING OF SAN MARCOS
FACILITY NUMBER: 374604385
VISIT DATE: 05/12/2026
NARRATIVE
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However, S1 noted that when the nurse called the facility about R1 the staff informed the nurse that R1 was sleepy because R1 had received Melatonin the previous night. On May 12, 2026, the department interviewed Resident (R2), who stated that R2 likes living here.

On May 12, 2026, the department reviewed the Medication Administration Records (MAR) dated August 14, 2024, and noted that Melatonin was not listed. However, the R1 hospital discharged medication list from September 13, 2024, the day of admission, confirmed that R1 was taking Melatonin 5 mg, among other medications. R1 was discharged from the hospital on September 23, 2024. The department also reviewed the facility notes dated September 12, 2024, which document all events before R1's hospitalization. On May 12, 2026, the department did not observe any Lorazepam 1 mg on the MAR or in R1's hospital discharge medication list.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited.

An exit interview was conducted. A copy of this report was provided to the Administrator Jim Morrison.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3