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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604689
Report Date: 07/09/2026
Date Signed: 07/09/2026 02:19:45 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
07/07/2026 and conducted by Evaluator Arian Golbakhsh
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20260707120452
FACILITY NAME:PARKER VILLAFACILITY NUMBER:
374604689
ADMINISTRATOR:ANNA EDIGARYVENAFACILITY TYPE:
740
ADDRESS:629 MICHAEL STTELEPHONE:
(442) 266-2254
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:6CENSUS: 5DATE:
07/09/2026
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Caregivers Melba Umayam and Royranger AntesTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Staff did not provide supervision for resident as required
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced visit to conduct a complaint investigation and delivered findings regarding the above mentioned allegation. LPA was welcomed by, identified themselves to, and discussed the purpose of their visit to Caregivers Melba Umayam and Royranger Antes. LPA additionally spoke over the phone to management staff Patrick Condez and Nickolas Lacson.

On 07/07/2026, the Department received a complaint where it was alleged that a resident (identified as R1) did not receive necessary supervision by staff. The Department’s investigation consisted of an unannounced facility visit, records review, and interviews with staff and residents.

[Continued on LIC 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
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-20260707120452
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: PARKER VILLA
FACILITY NUMBER: 374604689
VISIT DATE: 07/09/2026
NARRATIVE
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[Continued from LIC 9099]

Per the complaint, R1 had checked out of and left the facility at approximately 3:30pm on 7/5/26 and police were not contacted until 1am on 7/6/26, despite staff having located R1 around 11pm 7/5/26. Per the complaint report, police arrived at approximately 1:40am 7/6/26 and observed two staff members (identified as S1 and S2) leave R1 and return to the facility, which was around the corner of where S1, S2, and R1 were found by police. Per the complaint, R1 was described to be on the ground, soiled in urine, with their walker beside them. Police transported R1 back to the facility.

R1 is a resident at the facility with no diagnosis of Dementia or Mild Cognitive Impairment (MCI), per their physician's assessment dated 6/17/2024. The facility did not have a more recent assessment on file. Additionally, per the physician's assessment, R1 is unable to leave the facility unassisted.

Per review of facility records and interviews with staff and residents, the facility has "waivers" allowing residents to leave to and from the facility, claiming that the "Facility is not liable for any form of unexpected occurrence, harm, or injury obtained outside the facility," which is untrue. Per review of these "waivers," R1 did sign out 7/5/26 at 3:30pm and the recorded time of return was 2:20am. R1's facility file had copies of waiver sign in/outs dating back to April 2026. Interviews with two (2) staff members corroborated that R1 was returned by police on 7/6/26 in addition to it being revealed that they believed R1 was allowed to come and go from the facility unassisted and confirmed that R1 has been doing so, along with other residents that were named. Per review of all resident files, only three (3) of the five (5) current residents may leave the facility unassisted.

Interview with R1 revealed that they had fallen asleep while out alone in the neighborhood that afternoon and staff came and found R1 around 11pm, but that police had to come and assist R1 back to the facility. R1 additionally revealed that they go out the facility alone on a near daily basis. An interview was conducted with S1, who claimed they knew nothing of the incident aside from R1 having been brought back to the facility by police. S1 additionally claimed that they were not present at the facility during that date, despite having been identified as present in police records of the incident.

[Continued on LIC 9099-C]
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20260707120452
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: PARKER VILLA
FACILITY NUMBER: 374604689
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/06/2026
Section Cited
CCR
87464(f)(1)
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87464(f): Basic services shall at a minimum include: (1)Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).

This requirement is not med as evidenced by:
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Licensee will request for/obtain updated physician assessments for all residents and update the facility's check in/out policies for residents determined to be able to leave unassisted. Licensee will submit proof to LPA by POC due date.
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Based on file review and interviews, the Licensee did not ensure R1 was supervised as required when exiting facility grounds, posing an immediate health and safety risk to 1 out of 5 residents in care.
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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: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20260707120452
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: PARKER VILLA
FACILITY NUMBER: 374604689
VISIT DATE: 07/09/2026
NARRATIVE
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[Continued from LIC 9099-C]

Based on LPA's review of records, interviews with staff and outside sources, the preponderance of evidence standard has been met, therefore the above allegation of staff not having provided required supervision to a resident is found to be SUBSTANTIATED. A deficiency is being cited per California Code of Regulations, Title 22, Division 6 on the attached 9099D.

An exit interview was conducted with Managerial staff Patrick Condez over the phone, who gave permission to caregiver Antes to sign off on the report. Caregiver Antes was provided a copy of this report and the Licensee/Appeal Rights (LIC 9058). Their signature below confirms receipt of these documents.
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4