374604801-5-14-2025-08-AS-SJAB-DJUU5N-20250723151702

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604801
Report Date: 05/14/2025
Date Signed: 05/14/2025 01:36:37 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
05/07/2025 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20250507085139

FACILITY NAME:	CAVELARIS COMMUNITY CARE		FACILITY NUMBER:	374604801
ADMINISTRATOR:	MERZIOTIS, MARGAUX		FACILITY TYPE:	735
ADDRESS:	9975 SAN JUAN ST		TELEPHONE:	(619) 370-6733
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY:	22	CENSUS: 22	DATE:	05/14/2025
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Ron Locke, Staff & Phuc Huynh, Staff		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff did not ensure a client consumed an appropriate amount of liquid while in care
Staff screamed at a client while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to open a complaint on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Ron Locke, and Phuc Huynh, Staff to discuss the purpose of the visit.

LPA conducted conducted a tour of the facility, interviewed clients, facility staff, and outside sources and reviewed records. It was alleged that staff did not ensure a client consumed an appropriate amount of liquid while in care. Interviews revealed that Client 1 (C1) is able to get water, coffee and juice at any time. Interviews revealed that there is a 5 gallon water bottle that is in the dining room area that stays full and when it does get low, staff will refill the water. The water is always on the stand in the dining room available to the clients. LPA observation revealed the 5 gallon was full at the time of the visit. LPA has observed this same water stand and 5 gallon water in the facility at every visit. LPA also observed a large standing cooler that pours out the juice and a coffee container with coffee in it that both have spouts and are readily accessible for the clients to get their own drinks.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

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-20250507085139

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: CAVELARIS COMMUNITY CARE	FACILITY NUMBER: 374604801
	VISIT DATE: 05/14/2025

NARRATIVE

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Interviews with clients revealed that the water is always there and they usually have cups on the tables for them to grab and get something to drink. Interviews also revealed if all of the cups are gone off of the table they can ask staff for a cup to get something to drink. Interviews with C1 revealed they always drank water, coffee or juice. C1 stated that the facility staff always have the drinks available for all clients. C1 stated they were able to leave their room and get snacks and drinks anytime they wanted. Interviews with C1 revealed that C1 wore normal undergarments while at Cavelaris and now that they have been in the nursing home they are now wearing Depends undergarments. According to outside source interviews, C1 was continent while living at the facility. Interview revealed that C1 was diagnosed with being incontinent on May 8, 2025 once they were hospitalized. Interviews with staff also revealed that C1 wore regular undergarments.

It was alleged that staff screamed at a client while in care. Interviews revealed the staff treat all clients with respect. Interviews revealed the staff work closely with the clients and assist them with their needs. There were no complaints from the clients about the staff yelling at them. Interviews with staff revealed they do not yell at the clients.

The investigation did not produce supporting evidence or supporting witness statements to substantiate staff did not ensure a client consumed an appropriate amount of liquid while in care and staff screamed at a client while in care. Based on the evidence obtained from interviews, and record review, the complaint allegations are unsubstantiated.

An exit interview was conducted with Phuc Huynh, Staff and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

LIC9099 (FAS) - (06/04)

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