374604422-10-2-2025-08-AS-BCHN-DM78PY-20251005224215

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604422
Report Date: 09/30/2025
Date Signed: 10/02/2025 03:34:06 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
03/08/2022 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20220308132302

FACILITY NAME:	LA JOLLA CASA PACIFICA		FACILITY NUMBER:	374604422
ADMINISTRATOR:	FERNANDEZ, JENNIFER		FACILITY TYPE:	740
ADDRESS:	5468 PACIFICA DR		TELEPHONE:	(858) 775-6935
CITY:	LA JOLLA	STATE: CA	ZIP CODE:	92037
CAPACITY:	6	CENSUS:	DATE:	09/30/2025
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Jennifer Fernandez		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff sexually abused resident
Staff physically abused resident resulting in injuries
Facility did not provide hygiene supplies
Facility did not ensure face masks were available to visitors.
Licensee did not comply with reporting requirements

INVESTIGATION FINDINGS:

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*** This is an Amended Report ***

On 9/30/2025, LPA Grace Donato conducted a telephone interview with the facility to deliver findings. LPA spoke with Administrator Jennifer Fernandez and explained the purpose of the call.

Regarding the allegation of staff sexually abused resident and physically abused resident resulting in injuries, Reporting party (RP) stated that on 3/3/22 early in the morning, resident (R1) had been molested by a night time staff member (S1).

During the course of the investigation, staff members were interviewed, and records were reviewed.

On S1s interview, S1 shared that R1 will be combative and difficult when being changed. Sometimes R1 will be fine, but typically R1 is difficult and will resist. During R1s change, R1 was “screaming and yelling.” S1 denied grabbing or striking R1s legs.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

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-20220308132302

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: 09/30/2025

NARRATIVE

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R1s primary physician (DR) was interviewed, as well as R1s hospice provider registered nurse (W1). The hospice medical records for R1 were obtained. Both the DR and W1 affirmed R1s mental state may be a factor in the allegation disclosures by R1. Facility staff were interviewed, as well as S1, who denied the allegations. There were no other staff present in the home when the alleged abuse occurred. The investigation for the allegations of physical and sexual abuse will be closed as unsubstantiated at this time.

For the allegation of facility did not provide hygiene supplies, RP states that they have visited R1 in the past, and noticed there were no paper towels in R1s bathroom and asked staff for paper towels but was told 'there are none'.

The Department conducted a visit last 3/10/2022. LPA observed 3 bathrooms. Bathroom #1 is used for visitors and staff, LPA observed paper towels and hand soap. Bathroom #2 is not used. The bathroom was empty. Bathroom #3 is used only by R3, LPA observed paper towels and hand soap there. LPA requested to see the stock of supplies. LPA also observed 2 medium sized bottles of hand soap and ¼ hand soap left in a large container. LPA also observed two small rolls of paper towels. LPA was taken to the garage and a nearby office where LPA observed approximately 8 boxes of gloves, approximately 7 small bottles of hand sanitizer, 2 small bottles of hand soap, various packages of diapers and some wipes. LPA asked staff member, S3, what the facility policy is when staff run out of hygiene items- S3 stated that there is another facility ten minutes away where they can obtain items from and they can also call the Administrators who can bring some. S3 indicated that they all have been informed to request more items when needed.

Regarding the allegation of facility did not ensure face masks were available to visitors, RP stated that when they visited they asked for a mask, but RP was told 'there are none'.

LPA requested to see the stock of masks, S3 could not find any. S3 stated that due to a COVID outbreak at another facility, the Administrators took PPE to that facility. S3 also stated that staff bring their own masks. LPA asked what staff do if a visitor does not have a mask, S3 indicated that they can provide one for the visitors, but there were no extra masks to provide. LPA asked what the facility policy was if a visitor arrives without a mask. S3 stated that this has not occurred yet, but that the facility would provide a mask for them.

Regarding the allegation of Licensee did not comply with reporting requirements, RP stated that S1 did not notify Licensing or Law Enforcement of this incident.

LPA asked S3 about S3s knowledge of CCLD reporting requirements if S3 knew what a mandated reporter was, S3 demonstrated understanding. S3 stated that most paperwork is handled by the facility Administrators.

Based on interviews, observations and records review, the department has determined that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Report is reviewed and copy is provided.

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SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

LIC9099 (FAS) - (06/04)

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