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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374605111
Report Date: 06/29/2026
Date Signed: 06/29/2026 09:35:02 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
06/19/2026 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20260619154520
FACILITY NAME:BELLAHOMECARE IIIIFACILITY NUMBER:
374605111
ADMINISTRATOR:COOK, CHERRYFACILITY TYPE:
740
ADDRESS:483 QUINCETELEPHONE:
(406) 998-8022
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:6CENSUS: 5DATE:
06/29/2026
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Caregiver, Mary Ann JovenTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not administer medications to a resident as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to commence and investigation regarding the above allegation. LPA was granted entry into the facility by Caregiver Mary Ann Joven. During the visit, LPA spoke by telephone with Administrator Cherry Cook and explained the purpose of the visit.

The investigation included facility observations, record reviews, and interviews with staff, residents, and outside sources.

On June 19, 2026, Community Care Licensing (CCL) received a complaint alleging that facility staff administered medication to a resident that belonged to another resident.

(continue at LIC9099C)
Unsubstantiated
Estimated Days of Completion: 90Days
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
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 2
Control Number 08-AS-20260619154520
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: BELLAHOMECARE IIII
FACILITY NUMBER: 374605111
VISIT DATE: 06/29/2026
NARRATIVE
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(Continue from LIC9099)

Based on record reviews and interviews conducted on June 29, 2026, the investigation determined that the allegation stemmed from a miscommunication regarding medication management. Records showed that Resident 1 (R1) was admitted to the facility on June 1, 2026, with a diagnosis of Alzheimer's disease and was experiencing difficulty adjusting to the new environment, including exhibiting altered behaviors.

Interviews with staff and an outside source revealed that the Administrator had repeatedly requested that R1's responsible party contact R1's physician to obtain an evaluation for possible medication to address R1's behavioral changes. The outside source confirmed that the concern involved repeated requests to obtain a medication order and clarified that they did not report that facility staff administered medication belonging to another resident. The investigation also determined there was a delay in obtaining an evaluation because R1's physician was unavailable.

A review of R1's medication administration records and interviews with relevant parties found no evidence that facility staff administered medication that was not prescribed to R1 or medication belonging to another resident.

Based on observations, interviews, and record reviews, there was insufficient evidence to corroborate the allegation. Although the alleged incident may have occurred, the investigation did not produce a preponderance of evidence to support that facility staff administered medication belonging to another resident. Therefore, the allegation is deemed unsubstantiated.

An exit interview was conducted with Caregiver Mary Ann Joven and via telephone Administrator, Cook. A copy of this report, the LIC 811 Confidential Names List, and the Licensee Rights (LIC 9058 03/22) were provided at the conclusion of the visit.
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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