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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604801
Report Date: 08/07/2025
Date Signed: 08/08/2025 11:52:16 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
04/22/2025 and conducted by Evaluator Angelica Boyles
COMPLAINT CONTROL NUMBER: 08-AS-20250422091543
FACILITY NAME:CAVELARIS COMMUNITY CAREFACILITY NUMBER:
374604801
ADMINISTRATOR:MERZIOTIS, MARGAUXFACILITY TYPE:
735
ADDRESS:9975 SAN JUAN STTELEPHONE:
(619) 370-6733
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:22CENSUS: 20DATE:
08/07/2025
UNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:Phuc Huynh, CaregiverTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Staff does not ensure residents receive adequate bathing services while in care
Staff are not addressing issue of lice in the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to deliver investigative findings regarding the above mentioned allegation. LPA identified herself, explained the purpose of the visit and nature of the complaint to Phuc Huynh, Caregiver.

On April 22, 2025 the Department received this complaint which alleged staff does not ensure Resident #1 (R1) receives adequate bathing services while in care and staff are not addressing issue of lice in the facility. [See LIC811 Confidential Name List for a description of select person identifiers used in this report]. The Department’s investigation included a facility tour, record reviews, as well as interviews with residents and staff.

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
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-20250422091543
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: 08/07/2025
NARRATIVE
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(Continued from LIC9099)

Regarding the allegation that staff do not ensure R1 receives adequate bathing service while in care, records reviewed revealed that R1 is ambulatory and does not require assistance in bathing. R1 reported during an interview that staff prompt them to shower daily. R1 reported showering twice a week. LPA observed R1’s hygiene supplies used when showering. While interviews with other residents reported R1 does not shower regularly, they did report observing staff asking R1 to shower on a frequent basis. Interviews with staff corroborated prompting R1 to shower daily. Staff interviews also reported that they cannot force residents to shower.

Regarding the allegation that staff are not addressing lice in the facility, interviews with staff revealed that most residents have mobile doctors that come to the facility and if they observe lice they are treated. Staff interviews reported there has been a resident at times that will refuse treatment. Staff reported they cannot make residents get treatment if they do not want it. Staff further reported they will explain to the resident the benefit of treatment and encourage them to follow physician orders. Interviews with residents in care revealed that if a resident gets lice, the staff contact physicians to get the appropriate prescriptions to prevent the spread. There were no interviews that reported the facility did not address lice.

The Department has investigated the above allegations. Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate these allegations and therefore deemed unsubstantiated.

An exit interview was conducted with Phuc Huynh, Caregiver, to whom a copy of this report and the Licensee’s Rights (LIC9058 01/16) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
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