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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604908
Report Date: 05/06/2026
Date Signed: 09/23/2026 06:17:12 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
05/01/2026 and conducted by Evaluator Jose DeLaCruz
COMPLAINT CONTROL NUMBER: 08-AS-20260501100312
FACILITY NAME:HOPE HAVEN CAREFACILITY NUMBER:
374604908
ADMINISTRATOR:GONZALES, JOSE RAFAEL II BFACILITY TYPE:
740
ADDRESS:3724 ALASKA STREETTELEPHONE:
(619) 600-8462
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY:6CENSUS: 2DATE:
05/06/2026
UNANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:Licensee Lizelyn GonzalesTIME COMPLETED:
07:00 PM
ALLEGATION(S):
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Staff did not respect the residents reasonable accomodation right to room and roomate choices
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose De La Cruz conducted an unannounced visit regarding the above allegation. LPA was greeted by Licensee Lizelyn Gonzales (FA), to whom he identified himself and explained the purpose of the visit.

The reporting party (RP) alleged that a resident (R1) was required to share a room with a resident in the final stages of life (R2), without consent.

During an in-person visit on May 6, 2026, R1 was interviewed and confirmed that they shared a room with R2 for a few weeks, and described behaviors that were observed throughout the night as they were nearing death.


[CONTINUED ON LIC9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Jose DeLaCruz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026
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-20260501100312
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: HOPE HAVEN CARE
FACILITY NUMBER: 374604908
VISIT DATE: 05/06/2026
NARRATIVE
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[CONTINUED FROM LIC9099]



LPA toured the facility, interviewed a client, FA, and outside sources (OS3 and OS4), and requested records.

During an interview with FA, they acknowledged not consulting R1 before assigning them to share a room with R2, citing language compatibility as the reason. FA also mentioned that R2 moved to the facility from another facility managed by FA due to another resident who was R2's roommate at the time and having complained about the overnight noise made by R2.

During records review it was found on the admissions agreement that a section for "Roommate Consent for Hospice" was signed by R1's POA regarding awareness that the resident might share a room with a resident on hospice care and allowing hospice into the shared living space. LPA however could not find a document signed by R1 agreeing to the same. LPA considers R1 to be in a good state of mind, aware of time, place and social environment. They are also aware that they are in a facility and the services being provided, as well as the people, and their relations to them (staff, administrators, family).

Based on records reviewed, LPA observations, and interviews conducted with R1, and FA, the preponderance of evidence standard has been met, and the allegation is deemed substantiated.

One deficiency was cited per California Code of Regulations, Title 22 (refer to the LIC809-D page). Plan of Correction was jointly developed with the FA. An exit interview was conducted with Licensee Lizelyn Gonzales, to whom a copy of this report, the LIC 809-D pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.


Report and Appeal Rights discussed with and provided to Licensee Lizelyn Gonzales. Signature below confirms receipt.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Jose DeLaCruz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026
LIC9099 (FAS) - (06/04)
Page: 4 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
05/01/2026 and conducted by Evaluator Jose DeLaCruz
COMPLAINT CONTROL NUMBER: 08-AS-20260501100312

FACILITY NAME:HOPE HAVEN CAREFACILITY NUMBER:
374604908
ADMINISTRATOR:GONZALES, JOSE RAFAEL II BFACILITY TYPE:
740
ADDRESS:3724 ALASKA STREETTELEPHONE:
(619) 600-8462
CITY:SAN DIEGOSTATE:CAZIP CODE:
92154
CAPACITY:6CENSUS: 2DATE:
05/06/2026
UNANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:Caregiver Conchita D LabradorTIME COMPLETED:
07:00 PM
ALLEGATION(S):
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Staff did not respect the resident's personal rights to have visitors
Staff did not respect the residents personal rights to privacy
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose De La Cruz conducted an unannounced visit regarding the above allegation. LPA was greeted by Licensee Lizelyn Gonzales (FA), to whom he identified himself and explained the purpose of the visit.

R1 alleged that, following an argument with the Co-Administrator (CA), an outside source familiar to them (OS5) was asked to leave the facility and has not returned. R1 also reported concerns about privacy, stating that a male staff member (AP1) entered the restroom and looked into their room while they were changing, and that CA occasionally used R1’s room as an entry point from outside.



[CONTINUED ON LIC9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Jose DeLaCruz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20260501100312
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: HOPE HAVEN CARE
FACILITY NUMBER: 374604908
VISIT DATE: 05/06/2026
NARRATIVE
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[CONTINUED FROM LIC9099]

During an in-person visit on May 6, 2026, R1 reiterated the allegations. Regarding OS5, R1 said they were unsure why OS5 was asked to leave but speculated that it may have been due to OS5 wandering the facility and using areas without permission. Regarding privacy, R1 clarified they did not blame the unidentified male staff (AP1), stating that an unknown female staff (US) had asked AP1 to open a water valve during R1’s shower. R1 added that an unidentified staff member once looked through a partially open door but stated the incident had not occurred again.

R1 confirmed that CA entered their room unannounced twice, over two months ago, and acknowledged not reporting these concerns earlier because they did not want to “make a big deal” and were more concerned on personal issues.

LPA toured the facility, interviewed a client, FA, and outside sources (OS3 and OS4), and requested records. During the tour, LPA observed that doors connecting resident rooms to the exterior were locked.

FA could not identify US or AP1, noting that the same staff have been employed since opening and that hospice or home health workers are sometimes mistaken for facility staff. Regarding OS5, FA stated this issue had been previously discussed with LPA and involved OS5 attempting to override the POA’s decisions and intervening in care for other residents.

LPA tried to contact R1's POA (OS1), however they reached out OS3. Per OS3 they have not received any complaints regarding the facility or staff, and mentioned being aware of the situation with OS5. They mentioned not knowing the specific reason or circumstances, but clarified that they were related to R1, but they were not their POA.

Based on records reviewed, LPA observations, and interviews conducted with R1, clients (R3), FA and outside sources OS3 and OS4, the preponderance of evidence standard has not been met, and the allegation is deemed unsubstantiated. No deficiencies were cited in accordance with the California Code of Regulations.

Report and Appeal Rights discussed with and provided to Licensee Lizelyn Gonzales. Signature below confirms receipt.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Jose DeLaCruz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20260501100312
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: HOPE HAVEN CARE
FACILITY NUMBER: 374604908
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2026
Section Cited
CCR
87633(h)(5)
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(h) For each terminally ill resident ... in the facility, the licensee shall ...: (5) A statement signed by the resident's roommate...indicating his or her acknowledgment ..., and the roommate's voluntary agreement to grant access to... the resident's support network..."
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Residents no longer share room
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Based on interview and record review, the licensee did not comply with the section cited above in one out of two residents which posed a personal rights risk to one person 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: Robyn Clark
LICENSING EVALUATOR NAME: Jose DeLaCruz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5