374604780-2-23-2026-08-AS-SJAB-DRQ2TU-20260227164118

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604780
Report Date: 02/12/2026
Date Signed: 02/23/2026 10:33:52 AM

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
07/01/2025 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20250701114347

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: 6	DATE:	02/12/2026
		UNANNOUNCED	TIME BEGAN:	08:28 AM
MET WITH:	Eric Mendoza Caregiver		TIME COMPLETED:	10:29 AM

ALLEGATION(S):

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Lack of supervision resulting in resident being touched inappropriately

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced themselves and disclosed the purpose of the visit to Executive Director, Wes Hebner.

On 7/1/25, it was alleged that lack of supervision resulted in a resident being touched inappropriately. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review.

During the visit, the LPA observed staff coverage in common areas and residential corridors. Staff were present and engaged with residents, providing assistance and maintaining line-of-sight supervision consistent with Title 22 requirements. No unsafe supervision gaps or high-risk situations were observed. The environment appeared calm and organized, and staff demonstrated awareness of resident boundaries and safety.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20250701114347

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: 02/12/2026

NARRATIVE

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Staff 1 (S1) denied witnessing or being informed of any inappropriate touching and described standard supervision practices, including routine rounding and immediate intervention when residents require redirection. S1 confirmed understanding of mandated reporting requirements and facility protocols for responding to allegations of abuse.

Two (2) residents were interviewed; both denied experiencing or witnessing inappropriate touching and reported that staff are generally present and responsive in common areas.

Outside source 1 (OS1), reported no concerns regarding supervision and stated they had not been informed of any incidents of inappropriate contact. OS1 described staff interactions as professional and consistent with resident rights.

A review of facility records, including incident logs, communication notes, and staffing schedules, revealed no documented incidents confirming that a resident was touched inappropriately due to lack of supervision.

Staffing schedules matched observed coverage and indicated adequate ratios with qualified personnel on duty. Training records showed staff had completed in-service training on abuse prevention, professional boundaries, and mandated reporting requirements. Facility policies addressing supervision, abuse prevention, and reporting were current and consistent with regulatory standards.

Based on observations, interviews, and records reviewed, there is insufficient evidence to support the allegation that lack of supervision resulted in a resident being touched inappropriately. Therefore, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with Eric Mendoza, caregiver to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026

LIC9099 (FAS) - (06/04)

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