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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604894
Report Date: 04/29/2026
Date Signed: 04/30/2026 03:11:51 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
04/10/2026 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20260410143701
FACILITY NAME:MELROSE 36FACILITY NUMBER:
374604894
ADMINISTRATOR:MENDOZA, JUSTINFACILITY TYPE:
740
ADDRESS:14536 GARDEN RDTELEPHONE:
(702) 776-0689
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 5DATE:
04/29/2026
UNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:Administrator Justin MendozaTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Insufficient and Invalid Rate Increase Notice
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Correia conducted an unannounced visit to initiate a complaint investigation. LPA was greeted by Administrator (ADM) Mendoza, identified herself, and explained the purpose of the visit.

On April 4, 2026, the Department received a complaint alleging that the facility issued a notice of change in monthly rate that did not meet the criteria outlined in State Mandate and the Health and Safety Code. During today’s visit, LPA conducted interviews with facility staff and outside sources and obtained pertinent records.

A review of the facility’s notification regarding the monthly rate increase revealed that the change was scheduled to take effect 89 days from the date of the letter.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
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 3
Control Number 08-AS-20260410143701
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: MELROSE 36
FACILITY NUMBER: 374604894
VISIT DATE: 04/29/2026
NARRATIVE
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[Continuation of [LIC 9099]

Based on a facility/resident records reviews and interviews with staff and outside sources the allegation was determined to be substantiated.

An exit interview was conducted with Administrator Mendoza, to whom a copy of this report (LIC 9099), the deficiency page (LIC D 9099D), and Licensee Appeal rights (LIC 9058) were provided at the conclusion of today's visit.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20260410143701
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: MELROSE 36
FACILITY NUMBER: 374604894
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/23/2026
Section Cited
HSC
1569.655(a)
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Increase...rates for elderly...; 90 days’ written notice...reasons...(a) a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 90 days’ prior written notice to the residents or the residents’ representatives setting forth the amount of the increase and the reason or reasons for the increase... description... costs, except for...rate due to a change in the level of care...

This requirement was not met as evidenced by:
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Administrator will reissue a new 90-day notice of the monthly rate increase by the POC due date.

Administrator provided proof of correction (copy of the resubmitted notice of rate increase) dated 4/23/2026.
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Based on a review of Resident 1 [R1] notification letter of rate increase was less than a 90 day notice prior to the effective date.
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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: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3