<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604717
Report Date: 06/12/2025
Date Signed: 06/12/2025 03:51:36 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
06/03/2025 and conducted by Evaluator Rebecca A Borunda
COMPLAINT CONTROL NUMBER: 08-AS-20250603135425
FACILITY NAME:HACIENDA MISSION SAN LUIS REY, THEFACILITY NUMBER:
374604717
ADMINISTRATOR:PEREZ, MARIANOFACILITY TYPE:
740
ADDRESS:4000 MISSION AVETELEPHONE:
(520) 797-4000
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:294CENSUS: 182DATE:
06/12/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Move-In Coordinator Shelley LarkinTIME COMPLETED:
03:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Unlawful Eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to open an investigation and deliver findings regarding the above mentioned allegation. LPA was greeted by, identified herself to, and explained the purpose of the visit and the basic elements of the complaint with Move-In Coordinator Shelley Larkin. LPA also spoke with Executive Director Mariano Perez during the visit.

During today’s visit, LPA observed residents in care, reviewed and obtained copies of facility records, and interviewed staff. LPA was away from the facility for approximately one hour between 12:30pm and 1:30pm.

The Department's investigation consisted of interviews with residents and staff, records review, and a tour of the facility. It was alleged that the licensee unlawfully evicted Residents 1 and 2 (R1 and R2). Interviews with staff and R1, as well as review of R1 and R2's admission agreement signed May 2025 revealed that R1 and R2 moved into the facility on 5/15/2025 under a respite stay of approximately one month.
Continued on LIC9099-C page...
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
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 5
Control Number 08-AS-20250603135425
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: HACIENDA MISSION SAN LUIS REY, THE
FACILITY NUMBER: 374604717
VISIT DATE: 06/12/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Interviews with staff revealed that facility management received multiple complaints from residents and staff regarding R1 and R2's behavior and comments. Interviews with staff revealed that R1 and R2 made multiple comments that residents felt were inappropriate, abrasive, and judgmental. Interviews with staff and R1 revealed that on 5/26/2025, the Executive Director spoke with R1 and R2 regarding their behavior and stated that their respite stay would need to be shortened and that R1 and R2 would need to leave the facility. Review of R1 and R2's admission agreement signed May 2025 revealed that residents could only be evicted from the facility via a written 30-day notice or a written 3-day notice with prior Department approval. The Executive Director confirmed in interviews that a written 30-day notice was not issued to R1 or R2 at any time. Review of documents received by the Department from the facility confirmed that a 3-day eviction notice was also not requested. Interviews confirmed that R1 and R2 vacated their apartment on 5/26/2025.

The Department has investigated the above-mentioned allegation and based on interviews and record review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency was cited for unlawful eviction and noted on the attached LIC9099-D page.

An exit interview was conducted with Executive Director Mariano Perez, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20250603135425
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: HACIENDA MISSION SAN LUIS REY, THE
FACILITY NUMBER: 374604717
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2025
Section Cited
CCR
87224(a)
1
2
3
4
5
6
7
87224 Eviction Procedures (a) The licensee may evict a resident... Thirty (30) days written notice to the resident is required...
This requirement has not been met as evidenced by:
1
2
3
4
5
6
7
Executive Director and Resident Care Director will receive eviction training and provide proof of training to the Department by POC due date of 7/11/2025.
8
9
10
11
12
13
14
Based on interviews and record review, the Licensee did not comply with the section cited above in that R1 and R2 were verbally evicted from the facility. This poses a potential personal rights risk to 182 of 182 residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
06/03/2025 and conducted by Evaluator Rebecca A Borunda
COMPLAINT CONTROL NUMBER: 08-AS-20250603135425

FACILITY NAME:HACIENDA MISSION SAN LUIS REY, THEFACILITY NUMBER:
374604717
ADMINISTRATOR:PEREZ, MARIANOFACILITY TYPE:
740
ADDRESS:4000 MISSION AVETELEPHONE:
(520) 797-4000
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:294CENSUS: 182DATE:
06/12/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Move-In Coordinator Shelley LarkinTIME COMPLETED:
03:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not provide a refund
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to open an investigation and deliver findings regarding the above mentioned allegation. LPA was greeted by, identified herself to, and explained the purpose of the visit and the basic elements of the complaint with Move-In Coordinator Shelley Larkin. LPA also spoke with Executive Director Mariano Perez during the visit.

During today’s visit, LPA observed residents in care, reviewed and obtained copies of facility records, and interviewed staff. LPA was away from the facility for approximately one hour between 12:30pm and 1:30pm.

The Department’s investigation consisted of interviews with residents and staff, review of facility records, and a tour of the facility. It was alleged that licensee did not provide a refund to Resident 1 and 2 (R1 and R2).
Continued on LIC9099-C page…
Unfounded
Estimated Days of Completion: 0
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20250603135425
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: HACIENDA MISSION SAN LUIS REY, THE
FACILITY NUMBER: 374604717
VISIT DATE: 06/12/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Interviews with staff and R1 and review of R1 and R2’s admission agreement signed May 2025 revealed that R1 and R2 moved into the facility on 5/15/2025 under a respite stay for approximately one month. Interviews with staff and R1 and review of R1 and R2’s fee schedule paperwork revealed that the daily rate for R1 and R2’s stay at the facility was $350, for a total of $10,500 for the month-long stay. R1 and R2 paid a deposit of $2,500 via check for their respite stay in April 2025 and paid $8,500 via check on 5/15/2025. Interviews with staff and R1 revealed that the amount on the second check was written incorrectly and R1 and R2 did not have a spare check to fill out at that time, therefore, R1 and R2 paid a total of $11,000 and had overpaid for their 30-day respite stay by $500. Interviews with R1 and staff did not reveal that R1 and R2 unknowingly overpaid upon move in and confirmed that there were discussions that R1 and R2’s stay could be extended, or the extra money would be refunded at a later date. On 5/26/2025, R1 and R2 were asked to move out of the facility by the Executive Director and they vacated their apartment on the same day, terminating the admission agreement. This resulted in R1 and R2’s stay only consisting of 12 days from 5/15/2025 to 5/26/2025. Review of R1 and R2’s admission agreement revealed that the facility’s refund policy stated that any prepaid unused fees minus any expenses incurred by the facility to repair or replace damaged property and remove or store any belongings left behind would be refunded within 30 calendar days of the termination of the agreement. Interviews with staff and R1 revealed that R1 and R2 received a full refund of the total $11,000 paid to the facility 15 days later, on 6/10/2025.

The Department has investigated the above-mentioned allegation and based on interviews and records review, this allegation is deemed unfounded, meaning that the allegation was false, could not have happened, or is without reasonable basis.

An exit interview was conducted with Executive Director Mariano Perez, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5