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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603395
Report Date: 08/19/2026
Date Signed: 08/19/2026 03:06:38 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
03/17/2023 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 08-AS-20230317134311
FACILITY NAME:SUNRISE ASSISTED LIVING AT LA JOLLAFACILITY NUMBER:
374603395
ADMINISTRATOR:RICHARDSON, PAULFACILITY TYPE:
740
ADDRESS:810 TURQUOISE STTELEPHONE:
(858) 488-4300
CITY:SAN DIEGOSTATE: CAZIP CODE:
92109
CAPACITY:0CENSUS: DATE:
08/19/2026
UNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:TIME COMPLETED:
02:42 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff mismanaged residents’ medication
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) J. Clancy-Czuleger sent this report to the former licensee at their last known mailing address via USPS-certified mail and via email to deliver the investigation findings for the above allegations. The facility ceased operations on or about 08/24/2024.
During the course of the investigation, The Department conducted interviews with staff, residents, and witnesses. The department collected and reviewed the following documents:
On the allegation: Staff mismanaged residents’ medication.
In interview with Staff 5 (S5) stated that on Friday, March 10, 2023, Staff 6 (S6) gave Resident 1 (R1) their evening dosage of medication at 5pm but wasn't able to chart it.

Continued on LIC 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026
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 4
Control Number 08-AS-20230317134311
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: SUNRISE ASSISTED LIVING AT LA JOLLA
FACILITY NUMBER: 374603395
VISIT DATE: 08/19/2026
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 LIC 9099

S6 was supposed to make a progress note stating it was given but S6 didn't do that. The next Med Tech, Staff 7 (S7) came on and saw the medication wasn't given via the MAR and gave a dose to R1 at 7:50-8:00 pm. S6 was still working and noticed the medication was given again and S6 called S5 to let her know.

Based on the evidence obtained during the complaint investigation, the allegations were found to be SUBSTANTIATED, as there is a preponderance of evidence to prove the alleged violations occurred. A copy of this report, along with Licensee/Appeal Rights (LIC 9058), was mailed via USPS Certified Mail to the former licensee’s mailing address on file.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
03/17/2023 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 08-AS-20230317134311

FACILITY NAME:SUNRISE ASSISTED LIVING AT LA JOLLAFACILITY NUMBER:
374603395
ADMINISTRATOR:RICHARDSON, PAULFACILITY TYPE:
740
ADDRESS:810 TURQUOISE STTELEPHONE:
(858) 488-4300
CITY:SAN DIEGOSTATE:CAZIP CODE:
92109
CAPACITY:0CENSUS: DATE:
08/19/2026
UNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:TIME COMPLETED:
02:42 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not treat resident with dignity
Staff handled resident in a rough manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) J. Clancy-Czuleger sent this report to the former licensee at their last known mailing address via USPS-certified mail and via email to deliver the investigation findings for the above allegations. The facility ceased operations on or about 08/24/2024.

During the course of the investigation, The Department conducted interviews with staff, residents, and witnesses. The department collected and reviewed the following documents:

On the allegation: Staff did not treat resident with dignity.
Based on interviews, on Friday, March 10, 2023, there was a physical altercation
Continued on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026
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 4
Control Number 08-AS-20230317134311
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: SUNRISE ASSISTED LIVING AT LA JOLLA
FACILITY NUMBER: 374603395
VISIT DATE: 08/19/2026
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 LIC 9099A

between S1 and R1 while S1 was giving R1 a Covid test. Staff that were present for the altercation stated that S1 did push R1 resulting in a fall, but no comments or words were said to R1 by S1. Other visitors and staff interviewed stated that they have not witnessed S1 or other staff yell at S1 or other residents.

On the allegation: Staff handled resident in a rough manner.

Based on interviews, Staff 1 (S1) stated that on Sunday, March 5, 2023, that Staff 2 (S2) was trying to give a COVID test to Resident 2 (R2) who was agitated and didn’t know what was going which ended up with R2 hitting S2. In response the S2 put their hands on the R2’s neck and pushed R2 and R2 fell. In a different interview with Staff 4 (S4) it was stated that Staff 6 (S6) was the med tech who was giving the COVID test to R2 and had the altercation with R2. R1 has been diagnosed with dementia and when interviewed by LPA R2 was unable to answer questions like the date or day of the week and was unable to communicate well.

Based on staff interviews, outside source interviews, and records review, a preponderance of evidence does not exist to prove that the alleged violations occurred, therefore the allegations are UNSUBSTANTIATED. A copy of this report, along with Licensee/Appeal Rights (LIC 9058), was mailed via USPS Certified Mail to the former licensee’s mailing address on file.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4