374604388-12-11-2025-08-AS-SJAB-DPVQFG-20251231110754

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604388
Report Date: 12/11/2025
Date Signed: 12/11/2025 03:08:58 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
12/08/2025 and conducted by Evaluator Janet Ngallo

COMPLAINT CONTROL NUMBER: 08-AS-20251208155229

FACILITY NAME:	SUNSET CLIFFS ELDER CARE		FACILITY NUMBER:	374604388
ADMINISTRATOR:	TRAVONNA WASHINGTON		FACILITY TYPE:	740
ADDRESS:	1039 SANTA BARBARA STREET		TELEPHONE:	(619) 791-5495
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92107
CAPACITY:	6	CENSUS: 6	DATE:	12/11/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Travonna Washington		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff is not providing adequate supervision resulting in resident sustaining multiple falls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced visit to initiate a complaint investigation and deliver findings regarding the above-mentioned allegation. LPA identified themselves and met with administrator Travonna Washington, to discuss the purpose of the visit and elements of the complaint. Facility Manager Vinny Rathi later joined the visit.

On 12/08/2025, it was alleged that staff is not providing adequate supervision resulting in a resident sustaining multiple falls. The Department’s investigation consisted of an unannounced facility visit, interviews with facility staff, residents, an outside source, and a review of facility records.

(Cont. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025

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 08-AS-20251208155229

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: SUNSET CLIFFS ELDER CARE	FACILITY NUMBER: 374604388
	VISIT DATE: 12/11/2025

NARRATIVE

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(Cont. from LIC 9099)

Regarding the allegation, staff consistently stated that Resident 1 (R1), who has a diagnosis of dementia, received consistent supervision throughout the day and night. Staff reported conducting frequent checks, particularly due to R1’s inability to use the call alarm system and increased ambulation associated with a recent urinary tract infection. Staff confirmed that R1’s authorized representative and medical provider were notified following the most recent fall, and that environmental adjustments, such as removing furniture and adding fall mats, were being discussed.
Resident 2 (R2) stated that R1’s bedroom door was sometimes open and sometimes closed, and reported hearing about R1’s fall from staff. R2 had not witnessed any incidents but had observed staff interacting with and assisting R1.

Outside Source 1 (OS1), R1’s authorized representative, stated that the facility promptly informed them of the fall and consistently communicates regarding R1’s care. OS1 stated that they were confident that the facility was doing its best to supervise R1 and had been responsive to concerns about room safety.

Records reviewed included R1’s plan of care, resident appraisal, physician’s report (LIC 602), needs and services plan, emergency room documentation, communication records, staffing schedules, and rosters. These documents consistently described R1 as ambulatory, requiring one-person assistance with ADLs, and needing structured routines and supervision due to dementia and a history of UTIs. Records confirmed timely notification to R1’s authorized representative and adequate staffing levels during the relevant time period.

The LIC 602, plan of care, needs and services plan, and other reviewed records provided consistent information and corroborated the staff, resident, and outside source interviews regarding the allegation.

(Cont. on LIC 9099-C pg.2)

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20251208155229

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: SUNSET CLIFFS ELDER CARE	FACILITY NUMBER: 374604388
	VISIT DATE: 12/11/2025

NARRATIVE

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(Cont. from LIC 9099-C pg. 1)

LPA observed R1 ambulating throughout the facility and noted visible bruising and minor facial injuries. R1 demonstrated signs of confusion during the interaction. LPA observed R1’s bedroom, which contained multiple furniture items, including a large China cabinet. LPA advised the facility manager to consider fall risk mats in R1’s room.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violations occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator Travonna Washington, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided and their signature on this report confirms receipt of the Licensee Rights.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025

LIC9099 (FAS) - (06/04)

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