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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604612
Report Date: 12/28/2023
Date Signed: 12/28/2023 11:21:07 AM

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
09/08/2023 and conducted by Evaluator Renita Hall
COMPLAINT CONTROL NUMBER: 08-AS-20230908154150
FACILITY NAME:VICTORIOUS LIVING RESIDENCEFACILITY NUMBER:
374604612
ADMINISTRATOR:GONZALEZ, EDUARDO JR.FACILITY TYPE:
735
ADDRESS:9231 GOLONDRINA DRTELEPHONE:
(619) 303-0560
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY:4CENSUS: 2DATE:
12/28/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Melinda Pontanares, AdministratorTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Staff did not treat client with dignity and respect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to deliver findings. LPA was allowed entry by Genaro Suarez, Administrator. LPA identified herself and disclosed the purpose of the visit and elements of the findings with the Administrator and was later joined by Melinda Pontanares, Administrator who continued with the exit interview.

On September 8, 2023, the Department received a complaint regarding staff not treating client with dignity and respect. The Department investigated the above-listed complaint allegation. The investigation consisted of a tour of the facility, an interview with staff, and a records review.

The complainant did not provide any specific instances where they witnessed staff not treating the client with dignity and respect. A review of records indicated that Resident 1 (R1) had a history of aggressive behaviors towards staff, and family members with repeated property damage and AWOLs that resulted in police and PERT 51/50 interventions.
Continued on 9099C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023
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-20230908154150
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: VICTORIOUS LIVING RESIDENCE
FACILITY NUMBER: 374604612
VISIT DATE: 12/28/2023
NARRATIVE
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There was insufficient evidence found to support the allegation that staff did not treat R1 with dignity and respect.  Due to a lack of evidence, the allegation is deemed to be unsubstantiated.  An unsubstantiated finding means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Melinda Pontanares, Administrator.  A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Administrator and her signature on this report confirms receipt of the Licensee Rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2