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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370803192
Report Date: 09/12/2025
Date Signed: 09/12/2025 05:06:42 PM

Document Has Been Signed on 09/12/2025 05:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ARC OF SAN DIEGO-SOL AND RUTH GERBER FAMILY CENTERFACILITY NUMBER:
370803192
ADMINISTRATOR/
DIRECTOR:		OTERIA "TERI" MEDLEYFACILITY TYPE:
775
ADDRESS:1280 NOLAN AVENUETELEPHONE:
(610) 800-3635
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 186CENSUS: 131DATE:
09/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Program Administrator Susana LevackTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to conduct a Required Annual Inspection. The day program’s facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Program Administrator Susana Levack.

According to the facility license, the day program site has a maximum capacity for 186 clients, of whom 50 may be non-ambulatory, but none may bedridden. Per LPA observation, LIC602 Physician’s Reports, and staff interviews: During today’s inspection, there were a total of 131 clients enrolled, of whom 26 were non-ambulatory, and none were bedridden. The day program did not have endorsements for delayed-egress doors or secured perimeter doors, and neither of these were present.

LPA reviewed multiple client care records and multiple personnel files. LPA interviewed multiple staff and multiple clients, and toured the interior and exterior of the facility, inspecting all classrooms and common areas. The day program site was clean, sanitary, and in good repair. Doors, windows, toilets, shower, lighting fixtures, and drinking water dispensers were all working. Pathways were free of obstruction and slip hazards. There was sufficient space to facilitate client learning/activities, meetings, dining, and visitation.

The facility’s ambient internal temperature was complaint at 73 F. Where tested, hot water temperature at taps accessible to clients were compliant in temperature. Refrigerators and freezers used to preserve perishable food were complaint in temperature. There were snacks available for those clients who forget to bring their own lunch from home. Disposable plates and cutlery were present. There was a locked area for storage of medication. Confidential records were stored in locked areas. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC 809-C, 1 of 2]
NAME OF LICENSING PROGRAM MANAGER: Simon Jacob
NAME OF LICENSING PROGRAM ANALYST: Dang Nguyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ARC OF SAN DIEGO-SOL AND RUTH GERBER FAMILY CENTER
FACILITY NUMBER: 370803192
VISIT DATE: 09/12/2025
NARRATIVE
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[CONTINUED FROM LIC 809]

There were no toxic chemicals/poisons, open-faced heaters, or other hazardous objects accessible to clients. Smoke detectors, carbon monoxide detectors, emergency lighting, and facility telephone were all working. First Aid kits contained the required contents. The facility's fire extinguishers were serviced within the last twelve (12) months. The program does not have a fireplace or swimming pool (or similar body of water). Per the Licensee, no firearms or ammunition were kept at the day program site. Licensee presented proof of current business liability insurance.

During a review of client records, LPA observed, and manager interview confirmed: For 2 of 7 sampled clients [for Client #1 (C1) and Client #2 (C2)], Licensee did not have a signed Admissions Agreement contract for them, as required. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] For 3 of 7 sampled clients [C1, C2, and Client #3 (C3)], Licensee did not complete a Pre-Admission Appraisal for them, as required. For 7 of 7 sampled clients [C1 through Client #7 (C7)], Licensee did not have readily available the name, address, and telephone number of the client’s current primary care physician (PCP), dentist, and (where applicable) mental health provider(s), as required. For 1 of 7 sampled clients (C1), Licensee did not have proof that they advised the client and/or their responsible person of the Client’s Personal Rights at time of admission, as required.

During a review of personnel records, LPA observed, and manager interview confirmed: For 5 of 7 sampled staff [Staff #1 (S1) through Staff #5 (S5)], Licensee did not ensure their personnel records contained documentation of their educational background and prior training and/or work experience, as required.

Five (5) deficiencies were cited per California Code of Regulations, Title 22 (refer to the LIC809-D pages). Plans of Correction were jointly developed with the Licensee.

An exit interview was conducted with Program Administrator Susana Levack, to whom a copy of this report, the LIC809-D pages, the LIC811 Confidential Names List pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.
NAME OF LICENSING PROGRAM MANAGER: Simon Jacob
NAME OF LICENSING PROGRAM ANALYST: Dang Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 09/12/2025 05:06 PM - It Cannot Be Edited


Created By: Dang Nguyen On 09/12/2025 at 03:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ARC OF SAN DIEGO-SOL AND RUTH GERBER FAMILY CENTER
FACILITY NUMBER: 370803192

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82075(h)(1)
(h) There shall be at least one person in the day program at all times, who is capable of and responsible for communicating with emergency personnel. The following information shall be readily available to that person: (1) The name, address, and telephone number of each client's physician and dentist, and other medical and mental health providers, if any.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and manager interview, for 7 of 7 sampled clients (C1 through C7), Licensee did not have readily available the name, address, and telephone number of each client's physician and dentist, and other medical and mental health providers, if any. This posed a potential health risk to persons in care.
POC Due Date: 10/12/2025
Plan of Correction
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Licensee agreed to communicate with responsible persons to update the Facesheets for C1 through C7 to include the name, address, and telephone number for each clients' primary care physician (PCP), dentist, and (where applicable) mental health provider(s). If a client does not have a preferred dentist, Licensee may list a generic/default one who can be called for emergencies. Licensee agreed to E-mail the updated Facesheets for C1 through C7 to LPA, by the POC due date. Licensee agreed to independently audit all other clients' Facesheets for completeness.
Type B
Section Cited
CCR
80072(d)
80072 Personal Rights: “(d) At admission, a client and the client's authorized representative shall be personally advised of and given a list of the rights specified in Sections 80072(a)(1) through (10) and in the applicable Personal Rights sections of chapters 2 through 7.” This requirement was not met, as evidenced by:
Deficient Practice Statement
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Based on records review and manager interview, for 1 of 7 sampled clients (C1), Licensee did not at time of admission personally advise and give the client and their authorized representative a list of the rights specified in Sections 80072(a)(1) through (10) and in the applicable Personal Rights sections of chapters 2 through 7.” This posed a potential personal rights risk to persons in care.
POC Due Date: 10/12/2025
Plan of Correction
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Licensee agreed to coordinate with the responsible person (RP) for C1 to have them sign for LIC613 (Client’s Personal Rights), and to then upload this document to C1’s electronic record and to E-mail a copy of it to LPA, by the POC due date. Licensee agreed to independently audit all other clients’ records to ensure that they are not missing a signed LIC613 form.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Simon Jacob
NAME OF LICENSING PROGRAM MANAGER:
Dang Nguyen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2025


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 09/12/2025 05:06 PM - It Cannot Be Edited


Created By: Dang Nguyen On 09/12/2025 at 03:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ARC OF SAN DIEGO-SOL AND RUTH GERBER FAMILY CENTER
FACILITY NUMBER: 370803192

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82068(a)
Admission Agreements
(a) The licensee shall complete and maintain an individual written admission agreement with each client and the client's authorized representative, if any.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and manager interview, for 2 of 7 sampled clients (C1 and C2), Licensee did not complete and maintain an individual written admission agreement with the client and/or their authorized representative. This posed a potential personal rights risk to persons in care.
POC Due Date: 10/12/2025
Plan of Correction
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Licensee agreed to coordinate with the responsible persons (RPs) for C1 and C2 to sign admissions agreements for these clients, respectively. Licensee agreed to E-mail the executed contracts for C1 and C2 to LPA, by the POC due date. Licensee agreed to independently audit all other clients' records to ensure they are not missing an admissions agreement.
Type B
Section Cited
CCR
82068.2(a)
82068.2 Needs and Services Plan: “(a) Prior to admission, the licensee shall determine whether the day program can meet the prospective client's service needs.” This requirement was not met, as evidenced by:
Deficient Practice Statement
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Based on records review and manager interview, for 3 of 7 sampled clients (C1, C2, and C3), Licensee did not prior to admission complete an appraisal to determine whether the day program can meet the prospective client’s service needs. This posed a potential health risk to persons in care.
POC Due Date: 10/12/2025
Plan of Correction
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Licensee agreed to retroactively complete its “Client Info” appraisal form for C1, C2, and C3, and upload the document to those clients’ electronic records. Licensee agreed to E-mail the completed “Client Info” form for C1, C2, and C3 to LPA, by the POC due date. Licensee agreed to independently audit all other clients’ records to ensure that they are not missing a pre-admission appraisal.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Simon Jacob
NAME OF LICENSING PROGRAM MANAGER:
Dang Nguyen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2025


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 09/12/2025 05:06 PM - It Cannot Be Edited


Created By: Dang Nguyen On 09/12/2025 at 04:32 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ARC OF SAN DIEGO-SOL AND RUTH GERBER FAMILY CENTER
FACILITY NUMBER: 370803192

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82066(a)
82066 Personnel Records: “(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information: (6) Documentation of the educational background, prior and on-going training and/or experience.” This requirement was not met, as evidenced by:
Deficient Practice Statement
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3
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Based on records review and manager interview, for 5 of 7 sampled staff (S1 through S5), Licensee did not ensure that their personnel record contained documentation of educational background and prior training and/or experience. This posed a potential health and safety risk to persons in care.
POC Due Date: 10/12/2025
Plan of Correction
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Licensee agreed coordinate with S1 through S5 to have each person retroactively complete either and LIC501 Personnel record or an ARC Job Application to capture their required educational and work experience data. Licensee agreed to add these documents to their employee files, and to E-mail copies to LPA, by the POC due date. Licensee agreed to independently audit all staff files to ensure that they are not missing this data.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Simon Jacob
NAME OF LICENSING PROGRAM MANAGER:
Dang Nguyen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2025


LIC809 (FAS) - (06/04)
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