<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604894
Report Date: 06/24/2026
Date Signed: 06/24/2026 04:32:06 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
06/22/2026 and conducted by Evaluator Angelica Boyles
COMPLAINT CONTROL NUMBER: 08-AS-20260622173430
FACILITY NAME:MELROSE 36FACILITY NUMBER:
374604894
ADMINISTRATOR:MENDOZA, JUSTINFACILITY TYPE:
740
ADDRESS:14536 GARDEN RDTELEPHONE:
(858) 967-2176
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 6DATE:
06/24/2026
UNANNOUNCEDTIME BEGAN:
01:39 PM
MET WITH:Administrator Justin MendozaTIME COMPLETED:
03:54 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not ensure person with access to clients received a criminal record clearance.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 Administrator Justin Mendoza.

On June 22, 2026 the Department received this complaint which alleged the Licensee did not ensure person with access to clients received a criminal record clearance. The Department’s investigation included, record reviews, as well as interviews with staff, residents, and an outside source.

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

DATE: 06/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2026
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-20260622173430
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: 06/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/24/2026
Section Cited
CCR
80019(e)(2)
1
2
3
4
5
6
7
Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance...as required by the Department...
1
2
3
4
5
6
7
OS1 no longer resides/works at the facility, therefore the POC is satisfied.
8
9
10
11
12
13
14
This requirement was not met as evidenced by:

Per records reviewed and interviews, OS1 did not have criminal background clearance while working at the facility and residing on facility premise. This posed an immediate health and safety risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20260622173430
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: 06/24/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Continued from LIC9099)

According to Outside Source #1 (OS1) they were employed by the facility to do maintenance and while employed lived on the facility premises. [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] OS1 reported never completing a background check while working at the facility. OS1 reported they are no longer employed by the facility and no longer live on the property.

Interviews with facility staff corroborated OS1 being at the facility and performing various maintenance and landscaping duties inside and outside the facility. An interview with a resident also reported OS1 was at the facility fixing things on a regular basis. All interviews confirmed OS1 is no longer at the facility.

Per records reviewed, OS1 was never associated with the facility profile through the Department’s Guardian Background Check website, nor did the facility have any record of OS1 being fingerprinted cleared.

The Department has investigated this allegation and based upon the information obtained during this investigation, it is determined that the preponderance of evidence was met to support this allegation and therefore deemed substantiated.

One deficiency is being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page) and a Civil Penalty was assessed for a total of $500 (refer to attached LIC 421BG). A Plan of Correction was jointly developed with the Administrator. An exit interview was conducted with Administrator Justin Mendoza, to whom a copy of this report, the LIC 9099-D, LIC 421BG, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.

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

DATE: 06/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3