374604780-9-5-2025-08-AS-SJAB-DLSUD7-20250923152903

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604780
Report Date: 09/05/2025
Date Signed: 09/05/2025 02:34:44 PM

Unfounded

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
08/29/2025 and conducted by Evaluator Ramin Hashemi

COMPLAINT CONTROL NUMBER: 08-AS-20250829135252

FACILITY NAME:	LILOS TENDER SENIOR CARE INC		FACILITY NUMBER:	374604780
ADMINISTRATOR:	NAZARIAN, ANNIE		FACILITY TYPE:	740
ADDRESS:	9414 GROSSMONT BLVD		TELEPHONE:	(818) 284-2502
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	6	CENSUS: 4	DATE:	09/05/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Caregiver Paola Castillo		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff gave resident medication without a physicians order

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramin Hashemi conducted an unannounced visit to initiate a complaint
investigation regarding the above-mentioned allegation and deliver the finding. LPA introduced themselves and disclosed the purpose of the visit to Caregiver Paola Castillo.

It was alleged Staff gave resident medication without a physician's order. CCLD’s investigation involved an unannounced facility visit, review of facility records, interviews with facility staff, residents, outside sources, and LPA direct observations.

Regarding the allegation, staff interviews revealed that as a policy, the facility staff do not administer injections. Staff 1 (S1) stated Resident 1 (R1) does not do their own injections. When asked about R1's medication management, S1 stated R1 cannot manage their own medications and they travel to an outside medication management agency for insulin injections.

(continued on Page 2, LIC9099C)

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramin Hashemi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025

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 2

Control Number 08-AS-20250829135252

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: LILOS TENDER SENIOR CARE INC	FACILITY NUMBER: 374604780
	VISIT DATE: 09/05/2025

NARRATIVE

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(continued from Page 1, LIC9099)

Resident interviews revealed that when R1 was asked about insulin injections, they confirmed they have neither administered their own insulin at the facility, nor have they had any staff members administer it for them. R1 stated they've received their insulin injections from outside medication management agency. R1 was able to corroborate staff interviews.

Outside Source interviews revealed that Outside Source 1 (OS1) was not aware of R1 injecting themselves with insulin as part of their routine in the facility. OS1 confirmed R1's memory is not reliable. OS1 stated that in regards to the reporting party's incident report, it is very possible R1 could have misremembered the events when retelling the reporting party.

Records Review revealed that R1 takes oral medication to manage their diabetes. The medical administration record (MAR) has no indication of injectable insulin medications. The Physician's report indicated that while there is no direct mention of a diagnosed cognitive disorder, it is stated that there is "forgetfulness" and "other specified mental disorders due to known physiological condition" which corroborated outside source accounts of R1's memory impairment.

LPA observations revealed that inspection of the medications at the facility, R1 had no injectable insulin medications. All medications were prepackaged and provided by outside medication management agency and LPA was able to corroborate staff accounts of medication management.

Based on records and interviews, the allegation that Staff gave resident medication without a physician's order is unfounded, meaning it was false, could not have happened, and/or is without a reasonable basis. The allegation has therefore been dismissed. An exit interview was conducted with the Caregiver Paola Castillo, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramin Hashemi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025

LIC9099 (FAS) - (06/04)

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