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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604389
Report Date: 06/12/2026
Date Signed: 06/12/2026 08:55:20 AM

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
10/21/2022 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 08-AS-20221021083235
FACILITY NAME:BLUE SKIES OF TRI-CITYFACILITY NUMBER:
374604389
ADMINISTRATOR:RAFAEL GAMABFACILITY TYPE:
740
ADDRESS:3218 MIRA MESA AVE.TELEPHONE:
(619) 208-7869
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:0CENSUS: 0DATE:
06/12/2026
UNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:N/ATIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility staff did not treat resident with dignity
Facility staff forced resident to take medications
INVESTIGATION FINDINGS:
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On 10/26/22 at 11AM, Licensing Program Analyst (LPA) M. Garcia-Centeno arrived unannounced to conduct an initial 10- day investigation regarding the above allegations. LPA was greeted by staff (S3). LPA identified herself and discussed the purpose of the visit with S3. In addition, LPA spoke over the telephone with Licensee/Owner (LC) and Administrator (ADM) to whom she explained the purpose of the visit.

Allegation: Facility staff did not treat resident with dignity
Investigation Finding: Unsubstantiated
During investigation, LPA R. Ruiz conducted interviews with reporting party (RP), responsible party (POA), facility staff (LC, ADM) and obtained facility records. On 10/17/22 and 10/26/22, LPA R. Ruiz conducted interviews with RP and POA. On 10/06/22, POA expressed dissatisfaction with staff (S1) because she was verbally abusive, abrupt and rude towards R1. RP stated that she did not observe any of the behaviors described by POA during her weekly visits. On 06/08/26, LPA D Panlilio attempted to contact RP, POA and former staff (LC, ADM) with the phone numbers provided and found that the phones services were no longer valid and no messages could be left. Review of facility records confirmed Blue Skies of Tri-City closed on 03/25/25. Due to lack of obtainable information, the allegation could not be substantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that facility staff did not treat resident with dignity was found to be unsubstantiated. Continued on next page, LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026
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 2
Control Number 08-AS-20221021083235
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: BLUE SKIES OF TRI-CITY
FACILITY NUMBER: 374604389
VISIT DATE: 06/12/2026
NARRATIVE
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Allegation: Facility staff forced resident to take medications
Investigation Finding: Unsubstantiated
During investigation, LPA R. Ruiz conducted interviews with reporting party (RP), responsible party (POA) and facility staff (LC). POA stated that he met S1 on 09/04/22 and observed her to be rude to visitors, staff and residents. POA stated that on 10/02/22 at around 4PM, S1 attempted to pass medication to R1. R1 refused to take her medications and S1 attempted to force the medications into R1’s mouth. R1 continued to refuse the medications and told S1 to go away. Another staff member (S2) came into the room and convinced R1 to take her medications. S2 apologized to R1’s POA about S1’s behavior. RP stated that she did not observe any of the behaviors described by POA during her weekly visits. On 06/08/26, LPA D Panlilio attempted to contact RP, POA and former staff (LC, ADM) with the phone numbers provided and found that the phones services were no longer valid and no messages could be left. Review of facility records confirmed Blue Skies of Tri-City closed on 03/25/25. Due to lack of obtainable information, the allegation could not be substantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that facility staff forced resident to take medications was found to be unsubstantiated.

No deficiency cited during visit. Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2