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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601276
Report Date: 09/15/2026
Date Signed: 09/16/2026 08:38:18 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
10/04/2024 and conducted by Evaluator Angelica Boyles
COMPLAINT CONTROL NUMBER: 08-AS-20241004124648
FACILITY NAME:ANGEL'S GUEST HOME #1FACILITY NUMBER:
374601276
ADMINISTRATOR:JENKINS, PATRICIAFACILITY TYPE:
740
ADDRESS:9208 BELLAGIO RDTELEPHONE:
(619) 258-2013
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:6CENSUS: 6DATE:
09/15/2026
UNANNOUNCEDTIME BEGAN:
08:41 AM
MET WITH:Caregiver Zlota Levine
Administrator Monica Allan		TIME COMPLETED:
12:02 PM
ALLEGATION(S):
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Staff gave resident discontinued medication
Staff did not destroy discontinued medication
Staff did not follow physician's orders
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 allegations. LPA identified herself, explained the purpose of the visit and nature of the complaint to Caregiver Zlota Levine. Administrator Monica Allan later joined the visit.

On October 4, 2024 the Department received this complaint which alleged staff gave Resident #1 (R1) discontinued medication, staff did not destroy discontinued medication, and staff did not follow physician’s orders. [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] The Department’s investigation included a facility tour, a review of records, and interviews with staff.

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

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
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-20241004124648
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: ANGEL'S GUEST HOME #1
FACILITY NUMBER: 374601276
VISIT DATE: 09/15/2026
NARRATIVE
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(Continued from LIC9099)

Regarding the allegation that staff gave R1 discontinued medication, the Reporting Party specifies that R1 was given oxycodone. Per staff interviews and records reviewed, at the time of the alleged incident the facility did not keep a Medication Administration Record (MAR). Records collected at the time this investigation initially opened did not include anything to indicate R1 was given discontinued medication.

Regarding the allegation that staff did not destroy discontinued medication, records reviewed did not include any physician’s order for discontinuing oxycodone. Per the Centrally Stored Medication record for R1 around the time of this allegation, R1 was prescribed oxycodone with a prescription fill date of 1/11/24 and expiration date of 9/25. While there are no records indicating medication was destroyed, there are no physician's orders on file from that time to warrant the medication to be destroyed.

Regarding the allegation that staff did not follow physician’s orders, records reviewed did not include any physician’s order for discontinuing oxycodone.

The Department has investigated the above mentioned 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 Caregiver Zlota Levine, to whom a copy of this report and the Licensee’s Rights (LIC9058 3/22) were provided.

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

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
LIC9099 (FAS) - (06/04)
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