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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604644
Report Date: 02/09/2026
Date Signed: 02/09/2026 11:53:15 AM

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
02/03/2026 and conducted by Evaluator Renita Hall
COMPLAINT CONTROL NUMBER: 08-AS-20260203081128
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: 7DATE:
02/09/2026
UNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Sebastian Valdez, Caregiver
Rogelio Diaz, Licensee		TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility admissions contract includes incorrect stipulations
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 caregiver. LPA identified herself and disclosed the purpose of the visit and elements of the complaint to the caregiver and was later joined by the Licensee.

On February 3, 2026, the Department received a complaint alleging that the facility revised its Admission Agreement to state that no refunds would be issued to responsible parties, including in the event of a resident’s death, which is in violation of Title 22 regulations.

During the complaint investigation, the LPA reviewed the Admission Agreements for 7 residents and 2 of 7 residents currently residing at the facility had 18A clause in the agreement. The LPA determined that the Admission Agreements had been modified after the initial application packet was submitted to the Department.
Continued on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026
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-20260203081128
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: 02/09/2026
NARRATIVE
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The revised Admission Agreements included language stating that the facility would not provide refunds to responsible parties under any circumstances, including upon a resident’s death.

Title 22, California Code of Regulations, Section 87507(g)(5) requires that Admission Agreements include refund conditions, including refunds upon termination of residency. The facility’s revised Admission Agreements (number 18A for hospice care) failed to comply with this regulation by eliminating refunds, upon a resident’s death.

Based on records review, the allegation that the facility changed its Admission Agreement to not provide refunds to responsible parties, upon resident death for residents on hospice care, 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) were provided to the Licensee and his signature confirms receipt of these documents.
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20260203081128
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: 02/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2026
Section Cited
CCR
87507(g)(5)(A)
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(5)Refund conditions. (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652.
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To provided admended to admission agreement to the repsponsible parties that elimanates 18A clause for no refund for hospice care. By February 27, 2026
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The facility’s revised Admission Agreements for 2 of 7 residents eliminated refund provisions and were modified...This poses a potential financial harm to residents and responsible parties.. improperly denied refunds upon death.
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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: Sabel Martinez
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3