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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604422
Report Date: 09/05/2025
Date Signed: 09/05/2025 01:49:12 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
04/16/2025 and conducted by Evaluator Arian Golbakhsh
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250416111525
FACILITY NAME:LA JOLLA CASA PACIFICAFACILITY NUMBER:
374604422
ADMINISTRATOR:FERNANDEZ, JENNIFERFACILITY TYPE:
740
ADDRESS:5468 PACIFICA DRTELEPHONE:
(858) 775-6935
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY:6CENSUS: 3DATE:
09/05/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Caregiver Shahla MirzaeeTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Licensee did not follow reporting requirements regarding pending facility sale.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced visit to deliver findings regarding the above mentioned allegation. LPA was welcomed by, identified themselves to, and discussed the purpose of their visit to Caregiver Shahla Mirzaee. LPA spoke with Administrator Sonya Karpal over the phone as well to inform them of the reason for the visit and findings.

On 04/16/2025, the Department received a complaint where it was alleged that the facility owners did not follow reporting requirements in informing the Department and residents/their responsible parties of the home being sold. Per Title 22 Regulation 87109(b), the Department, residents and/or resident responsible parties must be informed a minimum of 30-days prior to the transfer of property or at the time a bona-fide offer is made, whichever is longer. The Department’s investigation consisted of unannounced facility visits, records review, and interviews with staff, residents, and outside sources.

[Continued on LIC 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
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 2
Control Number 08-AS-20250416111525
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: LA JOLLA CASA PACIFICA
FACILITY NUMBER: 374604422
VISIT DATE: 09/05/2025
NARRATIVE
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[Continued from LIC 9099]

The facility's Licensee did report to the Department on 4/15/25 that there was a pending sale of the property and provided an estimated date of escrow completion for 4/18/25. Outside sources interviewed all corroborated that the facility Administrator and/or Licensee communicated to them of intentions to sell the home and business through a change in ownership. One (1) outside source interviewed revealed that a written notification was provided on 4/15/25 and two (2) others revealed that they had been given verbal notice weeks earlier. File review of emailed communications confirmed that a notice was sent out to all resident responsible parties of the proposed change of ownership in both property and facility management on 4/15/25. Resident interviews revealed mixed information of if they were informed or not, but several communicated that their families would know for certain. Resident interviews did not reveal any concerns about their care or the transition to new owners. Staff interviews revealed that staff were not made aware of the impending change of ownership and learned through other means or after-the-fact. An outside source interview revealed that the official completion of sale occurred in June 2025, which was corroborated by a staff interview -- well past the required 30-days from 4/15/25.

Based on interviews and records review, while the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred – therefore the allegation has been determined to be UNSUBSTANTIATED. An exit interview was conducted with Caregiver Mirzaee to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2