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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604793
Report Date: 12/17/2025
Date Signed: 12/17/2025 12:16:37 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
10/15/2025 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20251015141940
FACILITY NAME:SUMMITS ARFFACILITY NUMBER:
374604793
ADMINISTRATOR:SANDOVAL, ERNESTOFACILITY TYPE:
735
ADDRESS:351 SAN MIGUEL DR.TELEPHONE:
(619) 734-7563
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:4CENSUS: 0DATE:
12/17/2025
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Manager Elizabeth RiveraTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Licensee employed surveillance cameras which record audio.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Manager Elizabeth Rivera.

The Complainant alleged that Licensee employed surveillance cameras at the facility which record audio. (CCLD permits video cameras in common areas, but not with audio recording, since the latter interferes with client’s ability to make phone calls and receive visitors with privacy and comfort.) CCLD’s investigation involved an unannounced facility tour/welfare check, interviews of pertinent facility managers, and review of camera footage live stream.

[CONTINUED ON LIC 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
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 6
Control Number 08-AS-20251015141940
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: SUMMITS ARF
FACILITY NUMBER: 374604793
VISIT DATE: 12/17/2025
NARRATIVE
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[CONTINUED FROM LIC 9099]

LPA observed, and manager interview confirmed: There were two (2) small black Blink-brand wireless cameras in the facility living room which transmitted a live feed to a smart phone in Licensee’s possession. Per LPA’s observation on 10/17/2025, it captured both video and audio. [LPA instructed Licensee to enter the cameras’ settings to deactivate audio recording, which was done in front of LPA that same day.]

Based on records and interviews, a preponderance of evidence exists to show Licensee employed surveillance cameras at the facility which recorded audio. The allegation was therefore Substantiated, and one (1) deficiency was cited for it per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). The Plan of Correction was completed that same day.

An exit interview was conducted with Manager Elizabeth Rivera, to whom a copy of this report, the LIC 9099-D page, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 08-AS-20251015141940
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: SUMMITS ARF
FACILITY NUMBER: 374604793
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2025
Section Cited
CCR
80072(a)(2)
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80072 Personal Rights: “(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: “(2) To be accorded…comfortable accommodations…to meet his/her needs.” This requirement was not met, as evidenced by:
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During LPA’s 10/17/2025 site visit, Licensee entered the cameras’ settings to deactivate audio recording. This action resolved the deficiency.
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Based on LPA observation and manager interview, Licensee did not accord 1 of 1 clients (C1) with comfortable accommodations to meet his/her needs. This posed a potential personal rights risk to a person in care.
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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: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
10/15/2025 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20251015141940

FACILITY NAME:SUMMITS ARFFACILITY NUMBER:
374604793
ADMINISTRATOR:SANDOVAL, ERNESTOFACILITY TYPE:
735
ADDRESS:351 SAN MIGUEL DR.TELEPHONE:
(619) 734-7563
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:4CENSUS: 0DATE:
12/17/2025
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Manager Elizabeth RiveraTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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-Licensee’s staff lacked language skill to communicate with client(s).
-Licensee’s staff did not give client needed medication.
-Licensee’s dog bit client at facility.
-Licensee did not fully meet communication requirements with responsible person.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver findings regarding the above prior complaint allegations. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Manager Elizabeth Rivera.

The Complainant alleged that Licensee’s staff lacked language skill to communicate with client(s), that Licensee’s staff did not give client needed medication, that Licensee’s dog bit client at facility, and that Licensee did not fully meet communication requirements with a client’s responsible person. CCLD’s investigation involved an unannounced facility tour/welfare check and interviews of C1 and pertinent staff and outside sources. The Department also reviewed relevant care and administrative records.

[CONTINUED ON LIC 9099-C, 1 of 2]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
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 6
Control Number 08-AS-20251015141940
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: SUMMITS ARF
FACILITY NUMBER: 374604793
VISIT DATE: 12/17/2025
NARRATIVE
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[CONTINUED FROM LIC 9099-A]

The Complainant said caregiver Staff #1 (S1) and another unspecified night-shift caregiver (Staff #2) lacked the language skills to communicate with Client #1 (C1) in English (the only language C1 spoke). [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] LPA interviewed S1 in English, finding S1 understood and quickly and appropriately answered LPA’s questions. The Complainant did not provide S2’s name but said S2 was a female caregiver on the night shift. Using manager interviews and the facility’s employee work schedule, LPA identified and interviewed all persons matching this description but could not find evidence of any facility caregiver being unable to speak English. Interviews aligned to show that multiple staff were bilingual, and they communicated with C1 in English.

The Complainant said during the late evening of 10/13/2025, C1 asked S1 for medication to relieve constipation, but S1 was unable to meet this request due to not understanding C1. The Complainant said it was not until the following day, on 10/14/2025, that C1 received said medication. LPA’s interviews of Complainant and facility management produced conflicting accounts as to the name of the specific constipation medication in question. However, per LPA’s review of C1’s medication records, leading up to 10/13/2025, C1 had just two (2) different prescribed medications to relieve constipation. The facility’s Medication Administrator Record (MAR) showed staff gave C1 both medications on 10/13/2025, consistent with how they were prescribed. The same was true regarding the days adjacent (preceding and subsequent) to 10/13/2025. In their own interview, C1 told LPA that staff regularly gave them their prescribed constipation-related medications, but such tablets were less than effective at relieving their symptoms.

The Complainant said there was an unspecified day when Licensee brought their pet dog to the facility, and that this dog bit C1’s leg. Prior to the complaint, Licensee had self-submitted a Special Incident Report (SIR) to CCLD, which showed: On C1’s move-in day to the facility, C1 whistled at and approached Licensee’s small Yorkshire Terrier dog, while barefoot. Staff #3 (S3) saw the dog become startled but denied seeing the dog bite C1’s foot, despite C1’s claim that it had. S3 pick up the dog and moved it to another room, then checked R1’s feet, finding no sign of injury. LPA’s investigation showed: The Complainant was not present during the alleged dog bite incident. C1 told LPA that Licensee’s dog bit C1 on their right foot, once. [CONTINUED ON LIC 9099-C, 2 of 2]
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 08-AS-20251015141940
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: SUMMITS ARF
FACILITY NUMBER: 374604793
VISIT DATE: 12/17/2025
NARRATIVE
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[CONTINUED FROM LIC 9099-C, 1 of 2] However, when LPA asked for permission to look at C1's feet for any sign of a prior bite or scratch, C1 refused to let LPA remove their shoes. C1 told LPA they had suffered no skin injury, and LPA saw nothing to dispute this. LPA interviewed S3, who corroborated the account provided in the SIR. LPA also interviewed Staff #4 (S4), the one other person at the facility during the alleged incident. S4 said they were nearby but did not witness the exact moment in question. S4 said they visually checked C1’s feet, and did not see any injury or mark.

The Complainant said in the past, C1’s responsible person (RP) had asked a facility manager Staff #4 (S4) care-related questions about C1. However, S4 kept replying via text message, despite RP specifically asking them for a return phone call, primarily because RP had arthritis in their hands. However, CCLD uncovered additional context. C1 is followed by San Diego Regional Center (SDRC). Interviews of facility managers and SDRC personnel showed around 10/02/2025, a care conference/meeting occurred involving C1, RP, SDRC case manager, and facility staff. At this meeting, they discussed how RP’s daily phone calls to facility staff about non-urgent matters were frequent enough, long enough, and/or to multiple enough staff, that said calls potentially interfered with delivery of care to C1. It was agreed at that meeting that communication boundaries should be implemented. Per interview of RP, S4 did generally answer their questions completely, albeit through text messages. During his own 10/17/2025 site visit, lasting around four (4) hours, LPA witnessed a facility caregiver speak on the phone with RP more than once, politely providing them updates on C1.

Based on records and interviews, a preponderance of evidence does not exist to show that Licensee’s staff lacked language skill to communicate with C1, that Licensee’s staff did not give C1 needed medication, that Licensee’s dog bit C1 at facility, or that Licensee did not fully meet communication requirements with C1’s responsible person. These allegations are therefore Unsubstantiated, and no deficiencies were cited for them.

An exit interview was conducted with Manager Elizabeth Rivera, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6