374601552-6-4-2026-08-AS-APAO-DV5MDK-20260617093116

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601552
Report Date: 06/04/2026
Date Signed: 06/04/2026 02:35:25 PM

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
05/20/2024 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20240520145352

FACILITY NAME:	LILY OF THE VALLEY II		FACILITY NUMBER:	374601552
ADMINISTRATOR:	ELISOL PUNAY		FACILITY TYPE:	740
ADDRESS:	11419 WESTONHILL DRIVE		TELEPHONE:	(858) 271-6849
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	0	CENSUS:	DATE:	06/04/2026
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Licensee, Christine Matthews		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Staff over medicated a resident in care
Facility did not seek medical attention in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud conducted a telephone visit to conclude the complaint investigation regarding the above mentioned allegation. LPA contacted Licensee, Christine Matthews to discuss the finding.

During the investigation, records were reviewed, and interviews were conducted with staff and outside sources. It was alleged that staff over medicated a resident in care and the facility did not seek medical attention in a timely manner. Both allegations were regarding Resident #1 (R1). On 05/04/24, an outside source visited R1 and R1 was very sleepy and could barely keep their eyes open. On 05/06/24 an outside source called the facility and spoke with staff who stated R1 was asleep. The outside source called back an hour later and staff stated R1 was asleep but fine. The third time the outside source called they were told the same thing, and requested staff wake R1 up because it was unusual for R1 to sleep all day and so late in the day. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240520145352

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: LILY OF THE VALLEY II	FACILITY NUMBER: 374601552
	VISIT DATE: 06/04/2026

NARRATIVE

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Staff continued to state R1 was fine. On 05/05/24, the administrator asked R1 if they wanted to go to the hospital but R1 refused. R1 confirmed they refused medical treatment. On 05/07/24, the administrator sent R1 out for evaluation and R1 agreed. The outside source reported that once R1 was transported to the hospital they were told R1 had kidney failure and might need dialysis. Then the hospital reported that R1’s kidneys were fine and R1 was in the hospital so they could treat a different medical condition. The outside source reported the hospital wasn’t aware of what they were doing. The outside source also reported that R1 was anxious and didn’t want to leave the facility. R1 was prescribed a new medication for their anxiety. It was unknown if the new medication caused the drowsiness. The outside source added that R1 was their own responsible party. The facility does not document medications dispensed on a Medication Administration Record. The administrator and staff explained that they read the bottle and followed the directions, there were no medication errors. A review of R1’s hospital records dated 05/07/24, indicated R1 had multiple medical conditions. One of the medical conditions was where the body, or part of it, does not receive enough oxygen to function properly. There was no evidence to corroborate R1 was over medicated, as their medical condition resulted in their symptoms. Resident interviews confirmed they are receiving medications as prescribed. The facility staff did not observe any concerns and asked R1 if they wanted to go to the hospital, which was initially declined. The facility sent R1 out for medical care when it was necessary, there was no delay in treatment.

During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations were deemed unsubstantiated. An exit interview was conducted and a

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

LIC9099 (FAS) - (06/04)

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