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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604895
Report Date: 09/22/2026
Date Signed: 09/24/2026 11:17:40 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
09/20/2026 and conducted by Evaluator Angelica Boyles
COMPLAINT CONTROL NUMBER: 08-AS-20260920151241
FACILITY NAME:MELROSE 48FACILITY NUMBER:
374604895
ADMINISTRATOR:MENDOZA, JUSTINFACILITY TYPE:
740
ADDRESS:14548 GARDEN RDTELEPHONE:
(858) 967-2176
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 5DATE:
09/22/2026
UNANNOUNCEDTIME BEGAN:
11:02 AM
MET WITH:Administrator Justin MendozaTIME COMPLETED:
03:18 PM
ALLEGATION(S):
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Residents were left without staff supervision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to initiate an investigation and deliver findings regarding the above mentioned allegation. LPA identified herself, explained the purpose of the visit and nature of the complaint to Administrator Justin Mendoza.

On September 20, 2026 the Department received this complaint which alleged residents were left without staff supervision. The Department’s investigation included a facility tour as well as interviews with staff and outside sources.

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

DATE: 09/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2026
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 3
Control Number 08-AS-20260920151241
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: MELROSE 48
FACILITY NUMBER: 374604895
VISIT DATE: 09/22/2026
NARRATIVE
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(Continued from LIC9099)

The facility is located on a multi-use property which includes four other licensed facilities. While LPA was at a facility next door to Melrose 48, LPA observed Staff #1 (S1) exit Melrose 48 and come into the facility LPA was at. LPA observed S1 grab plates and go back to Melrose 48. LPA followed S1 to Melrose 48 and observed there were no other staff in the facility. During the time S1 was at the facility next door, the residents had absence of supervision. Later, LPA again observed S1 exit Melrose 48 and enter the facility next door. S1 came to talk to the caregiver for about four minutes. LPA followed S1 back to Melrose 48 and again observed no other staff at the facility, resulting in the residents having no staff supervision during that time.

An interview with an Outside Source (OS1) reported that they had observed the residents in care with an absence of supervision on one occasion. OS1 reported it was a time frame of at least 10 minutes but could have been longer as there were no facility staff at the facility when she initially arrived.

The Department has investigated the allegation that residents were left without staff supervision. Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was met to support this allegation and therefore deemed substantiated.

One deficiency is being cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page) including a Civil Penalty totaling $500 (refer to LIC 421IM). A plan of correction was jointly developed with the Administrator. An exit interview was conducted with Administrator Justin Mendoza to whom a copy of this report and the Licensee/Appeal Rights (LIC9058) were provided at the conclusion of the visit.

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

DATE: 09/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20260920151241
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: MELROSE 48
FACILITY NUMBER: 374604895
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/02/2026
Section Cited
CCR
87411(a)
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(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...
This requirement is not met as evidenced by:
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Administrator agreed to have a staff training regarding supervision and submit proof of training to LPA by POC due date.
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Per LPA observation and interview with outside source, residents in the facility were without facility staff supervision. This poses an immediate health and safety risk to 5 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: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3