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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604644
Report Date: 05/12/2025
Date Signed: 05/12/2025 12:16:10 PM

Substantiated


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
05/02/2025 and conducted by Evaluator Renita Hall
COMPLAINT CONTROL NUMBER: 08-AS-20250502143825
FACILITY NAME:DIVINE LIGHT CARE HOMEFACILITY NUMBER:
374604644
ADMINISTRATOR:DIAZ, ROGELIOFACILITY TYPE:
740
ADDRESS:5105 BANCROFT DRIVETELEPHONE:
(619) 713-1053
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY:7CENSUS: 6DATE:
05/12/2025
UNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Rogelio Diaz, LicenseeTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Facility had more residents than licensed for
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to initiate a complaint investigation regarding the above-mentioned allegation. LPA was allowed entry by the Licensee. LPA identified herself and disclosed the purpose of the visit and elements of the complaint to the Licensee. This is an Amended reflect the Cenus at the time of visit was 7 instead of 6.

On May 12, 2025, the Department conducted a visit. During the visit, LPA conducted a tour of the facility and collected resident records. On May 2, 2025, a complaint was filed with the department by the Reporting Party that alleged the facility operated over capacity.

Resident 1 (R1) resided at the facility from December 14, 2024, to February 3, 2025, in room #8. During this time, the facility was licensed for a capacity of six residents but was in the process of obtaining an increase to seven. However, the fire clearance was not granted for room #8 to house a non-ambulatory resident due to construction requirements that had not yet been completed.
Continued on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
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 3
Control Number 08-AS-20250502143825
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: DIVINE LIGHT CARE HOME
FACILITY NUMBER: 374604644
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/12/2025
Section Cited
CCR
87204(a)
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(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. This requirement was not met:
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Plan of Correction has been completed fire clearance obtained, case management was done, and new license increase capacity issued on May 9, 2025
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This is evidence by: LPA review of license capacity and admission agreement. This
causes a Health and Safety violations for residents in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20250502143825
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: DIVINE LIGHT CARE HOME
FACILITY NUMBER: 374604644
VISIT DATE: 05/12/2025
NARRATIVE
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 Despite being aware that they could not operate over their licensed capacity, the facility admitted R1 before receiving the necessary fire clearance and license update. The Department was aware of the fire clearance issue in May 2024; however, R1 was no longer in care at the time of discovery. On May 9, 2025, the facility was officially granted an increase in capacity to seven. Health and Safety Code 87204 (a) cited for the deficiency.

Based on the information obtained, the allegation that the facility operated over capacity is substantiated, as there is a preponderance of evidence to prove the alleged violation occurred. An exit interview was conducted; a copy of this report, along with Licensee Appeal Rights LIC 9058 (REV 3/22), was provided to the Licensee, and his signature confirms receipt of these documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3