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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604686
Report Date: 06/04/2026
Date Signed: 06/04/2026 03:36:32 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
04/27/2026 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20260427120300
FACILITY NAME:4 PILLARS CARE LLCFACILITY NUMBER:
374604686
ADMINISTRATOR:SPIVEY, CARSONFACILITY TYPE:
735
ADDRESS:1641 CUYAMACA AVE.TELEPHONE:
(619) 834-9680
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:4CENSUS: 3DATE:
06/04/2026
UNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Carson Spivey, AdministratorTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff did not obtain timley medical care for resident
Due to lack of supervision, residents urinate in the neighborhood
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes contacted the facility to deliver findings for a complaint investigation. LPA identified herself to, and explained the purpose of the visit and the basic elements of the complaint with Carson Spivey, Administrator.

LPA previously conducted interviews with residents, staff, and outside sources, made observations, and obtained and reviewed pertinent records.

It was alleged that staff did not obtain timley medical care for resident and due to lack of supervision residents urinate in the neighborhood. Interviews revealed that there was an incident back in April 2026, where a client fell inside of the facility and busted their head on the bottom rock surface of the fire place. Interviews revealed that the client was bleeding and that 911 was called immediately following the incident. The client went to the hospital and was treated. Interviews revealed that the staff supervise the clients and that they have not observed any clients urinating outside. Interviews with clients revealed that the clients do not urinate outside and that they use the bathroom. Interviews with an outside source revealed they have not had or heard of any complaints of the clients using the bathroom outside. Interviews with an outside source also revealed that the ambulance was called right after the incident occurred after the staff observed the clients head. Interviews with staff deny that they didnt obtain timley medical care for resident and that they don't supervise the
clients.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
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 2
Control Number 08-AS-20260427120300
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: 4 PILLARS CARE LLC
FACILITY NUMBER: 374604686
VISIT DATE: 06/04/2026
NARRATIVE
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The Department has investigated the above-mentioned allegations and based on interviews, LPA observations, and records review, it was determined that the complaint allegations are Unsubstantiated. The allegations may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with Carson Spivey and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the end of the visit.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2