372000641-4-30-2026-08-AS-LTEZ-DWZRDK-20260816125605

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 372000641
Report Date: 04/30/2026
Date Signed: 04/30/2026 11:24:10 AM

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
03/03/2026 and conducted by Evaluator Janet Ngallo

COMPLAINT CONTROL NUMBER: 08-AS-20260303120623

FACILITY NAME:	WHITE SANDS LA JOLLA		FACILITY NUMBER:	372000641
ADMINISTRATOR:	SMART, SHELLY		FACILITY TYPE:	741
ADDRESS:	7450 OLIVETAS AVE		TELEPHONE:	(858) 454-4201
CITY:	LA JOLLA	STATE: CA	ZIP CODE:	92037
CAPACITY:	299	CENSUS: 267	DATE:	04/30/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Health Services Administrator Venus Jo and Executive Director Shelly Smart		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff spoke to a resident in an inappropriate manner.
Staff denied a resident food.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced subsequent visit to deliver findings regarding the above-mentioned complaint allegations. LPA identified themselves and met with Health Services Administrator Venus Jo and Executive Director Shelly Smart, to discuss the purpose of the visit and elements of the complaint.

On 03/03/2026, it was alleged that staff spoke to a resident in an inappropriate manner, and that staff denied a resident food. The department's investigation consisted of interviews and records review.

Regarding the allegation that staff spoke to a resident in an inappropriate manner, interviews confirmed that a staff member(S2) used an inappropriate phrase in the dining room towards a resident(R1). S2 acknowledged making the statement, and confirmed verbal counseling was given afterward. Dining management reported addressing the matter with the staff member, reviewing expectations, and had staff apologize to R1. R1 reported that the staff member used an inappropriate word but stated it had not happened since then. (Cont. on LIC 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026

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 5

Control Number 08-AS-20260303120623

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: WHITE SANDS LA JOLLA	FACILITY NUMBER: 372000641
	VISIT DATE: 04/30/2026

NARRATIVE

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(Cont. from LIC-9099)

Records review of facility HR email correspondence documented that the incident was reported by an employee witness(S1) and addressed by dining management.

Regarding the allegation that staff denied a resident food, the resident involved(R1) reported that a staff member refused to provide fruit after dinner service had ended. R1 reported that the staff member (S2) declined to retrieve the fruit, and that the concern was reported to dining management. S2 reported that residents may self-serve fruit before final closing and that after closing, S2 directed residents to other staff to receive food. Management reported addressing the concern with S2 as well.

Based on relevant interviews and records review, the preponderance of evidence has been met that the alleged violations occurred and is therefore substantiated. A deficiency is cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Health Services Administrator Venus Jo, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 5

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
03/03/2026 and conducted by Evaluator Janet Ngallo

COMPLAINT CONTROL NUMBER: 08-AS-20260303120623

FACILITY NAME:	WHITE SANDS LA JOLLA		FACILITY NUMBER:	372000641
ADMINISTRATOR:	SMART, SHELLY		FACILITY TYPE:	741
ADDRESS:	7450 OLIVETAS AVE		TELEPHONE:	(858) 454-4201
CITY:	LA JOLLA	STATE:CA	ZIP CODE:	92037
CAPACITY:	299	CENSUS: 267	DATE:	04/30/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Health Services Administrator Venus Jo and Executive Director Shelly Smart		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are not following resident's dietary plan.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 08-AS-20260303120623

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: WHITE SANDS LA JOLLA	FACILITY NUMBER: 372000641
	VISIT DATE: 04/30/2026

NARRATIVE

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(Cont. from LIC-9099A)

Regarding the allegation, interviews reported that dietary allergies are flagged in the computer ordering system, reviewed during staff line-ups, and displayed for cooks and servers. Staff stated that when the garlic concern was reported, the dining team reviewed the ingredients and found no indication that garlic had been added. The resident(R2) with the garlic allergy reported that they could not tell if there was garlic on the food served, that the incident and reaction was minor, and that staff are “very careful” and took appropriate steps after the concern.

Records review of the dining menu items on the date in question contained garlic in limited products, but there was no documentation confirming that garlic was served to the resident or that a dietary plan was violated. The food R2 described eating was not consistent with any food on the menu for the date in question.

LPA observed dining room clean, with allergen sign up warning residents about foods that may contain eggs, shellfish, peanuts, etc. LPA observed Dinning Director demonstrating how when a resident places an order, the allergen warning and what the resident is allergic to will come up. LPA observed this notice in bright red. LPA was informed this gets sent to the back of house staff that prepare the meals as well.

Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate the allegation and therefore deemed unsubstantiated.

An exit interview was conducted with Health Services Administrator Venus Jo, to whom a copy of this report and the Licensee’s Rights (LIC9058 01/16) were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20260303120623

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: WHITE SANDS LA JOLLA	FACILITY NUMBER: 372000641
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/30/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/30/2026 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	(a) Residents... personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The licensee agreed to conduct personal rights training for dinning staff and provide proof of training conducted regarding code of conduct and respectful communication.
	8 9 10 11 12 13 14	Based on interviews and records review, staff did not accord dignity to R1. This posed a potential personal rights risk to 1 out of 267 residents in care.	8 9 10 11 12 13 14
Type B 04/30/2026 Section Cited CCR 87555(b)(3)	1 2 3 4 5 6 7	(b)(3) Between-meal nourishment or snacks shall be made available for all residents unless limited by dietary restrictions prescribed by a physician.	1 2 3 4 5 6 7	The licensee agreed to conduct personal rights training for dinning staff as well as provide between-meal nourishments or snacks to residents in care. License will provide proof of training conducted for snack policy by POC due date.
	8 9 10 11 12 13 14	Based on interviews and records review, licensee did not make available between-meal nourishments or snacks to residents. This posed a potential personal rights risk to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026

LIC9099 (FAS) - (06/04)

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