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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601468
Report Date: 09/15/2026
Date Signed: 09/15/2026 06:18:33 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/15/2026 06:18 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:EMMAUS CARE IFACILITY NUMBER:
374601468
ADMINISTRATOR/
DIRECTOR:		JEANETTE MONILLASFACILITY TYPE:
740
ADDRESS:8738 COVINA STREETTELEPHONE:
(858) 566-4625
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: 6CENSUS: 5DATE:
09/15/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Licensee, Janette MonillasTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility by Staff, Julieta Espino. Licensee, Janette Monillas arrived during the visit.

LPA, accompanied by the licensee, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. However, there were unwanted items items being stored. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. However, the appropriate bedding was not present on residents beds. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. However, there were no N95's present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Hot water temperature at taps accessible to residents were all compliant and measured at 115 F.. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were toxic chemicals/poisons, and medications accessible to residents. The staff room was open, inside were medications and items that could pose a danger. In addition, there was a large amount of paint cans located in the backyard accessible to residents. Both were made inaccessible to residents during the visit. Medications were labeled, as required, and stored in locked areas. However, another resident's medications were stored with another resident's medications. Some medications did not have orders, and there were prescribed PRN medications that were expired. Also, there was an order on file for a PRN but the PRN medication was not available for the resident, and PRN medications were not being documented. Continued on LIC 809C.
Lizzette Tellez
Natasha Persaud
DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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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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Document Has Been Signed on 09/15/2026 06:18 PM - It Cannot Be Edited


Created By: Natasha Persaud On 09/15/2026 at 11:09 AM
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: EMMAUS CARE I
FACILITY NUMBER: 374601468

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/16/2026
Section Cited
CCR
87309(a)

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Storage Space and Access. Except ... the licensee shall ensure ...cleaning solutions, poisonous substances... and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
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Licensee removed the immediate threat and stored all items that pose a danger and staff room was also locked and made inaccessible during the visit, POC corrected.
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This requirement is not met as evidenced by: Based on observations, the licensee did not ensure items that could pose a danger were inaccessible to 4 out of 5 residents [R1-R4], which poses an immediate health and safety risk to residents in care.
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Type B
10/13/2026
Section Cited
CCR87465(h)(4)

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Incidental Medical and Dental Care. All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. This requirement is not met as evidenced by:
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Licensee stated they will ensure all prescribed medications are stored in the facility for resident use. Also, all expired medications will be documented on the CSMDR and destroyed by POC due date.
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Based on observations and interviews, the licensee did not ensure all prescribed medications were present and expired medications disposed of for 2 out of 5 residents [R1;R5], which posed a potential health and safety risk to 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.
Lizzette Tellez
NAME OF LICENSING PROGRAM MANAGER:
Natasha Persaud
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2026


LIC809 (FAS) - (06/04)
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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: EMMAUS CARE I
FACILITY NUMBER: 374601468
VISIT DATE: 09/15/2026
NARRATIVE
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No pools or bodies of water were observed on the premises. Per the licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. First aid kit was complete and readily accessible. However, the First Aid manual was not present. Required licensing postings were observed in visible areas of the facility. LPA reviewed multiple staff and resident records/files. The reviewed files did not contain required documents. Confidential records were stored in locked areas.

Deficiencies were observed or cited during today's annual inspection. Advisory notes were also issued. An exit interview was conducted with Licensee, Janette Monillas to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
NAME OF LICENSING PROGRAM MANAGER: Lizzette Tellez
NAME OF LICENSING PROGRAM ANALYST: Natasha Persaud
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/15/2026 06:18 PM - It Cannot Be Edited


Created By: Natasha Persaud On 09/15/2026 at 02:42 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: EMMAUS CARE I
FACILITY NUMBER: 374601468

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2026
Section Cited
CCR
87465(e)

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Incidental Medical and Dental Care. For every prescription and nonprescription PRN medication...shall be a signed, dated written order from a physician... maintained in the residents file ...medication. This requirement is not met as evidenced by:
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Licensee agreed to obtain orders for all resident's medications by POC due date.
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Based on observations and interviews, the licensee did not ensure medication orders were on file for 2 out of 5 [R1;R5] residents which posed a potential health and safety risk to residents in care.
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Type B
10/13/2026
Section Cited
CCR87465(c)(3)

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Incidental Medical and Dental Care. If the resident's physician...provided all of the following requirements are met: A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response.
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Licensee stated a PRN log was available, however, staff were not documenting. In addition, licensee stated staff will begin using PRN log again and staff will attend vendor training on medications by POC due date.
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This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not document PRN medications that were dispensed to 5 out 5 [R1-R5] residents, which posed a potential health and safety risk to 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.
Lizzette Tellez
NAME OF LICENSING PROGRAM MANAGER:
Natasha Persaud
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/15/2026 06:18 PM - It Cannot Be Edited


Created By: Natasha Persaud On 09/15/2026 at 02:53 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: EMMAUS CARE I
FACILITY NUMBER: 374601468

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2026
Section Cited
CCR
87615(a)(5)

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Prohibited Health Conditions. Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities. This requirement is not met as evidenced by:
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Licensee stated they overlooked R1's physician's report regarding capacity for self care. Licensee stated they will submit an exception by POC due date.
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Based on record review and interviews, the licensee retained 1 out of 5 residents [R1] with a prohibited health condition, which poses a potential health and safety risk to residents in care.
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Type B
10/13/2026
Section Cited
HSC1565(c)

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A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter...scenarios. An actual evacuation...during a drill. While a facility...shall not require that participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill.
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Licensee stated they will conduct a quarterly disaster drill with all staff in attendance and submit proof of training by POC due date.
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This requirement is not met as evidenced by:
Based on record review and interviews, the licensee did not conduct a quarterly disaster drill for 8 out 8 staff, which poses a potential risk to 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.
Lizzette Tellez
NAME OF LICENSING PROGRAM MANAGER:
Natasha Persaud
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/15/2026 06:18 PM - It Cannot Be Edited


Created By: Natasha Persaud On 09/15/2026 at 03:05 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: EMMAUS CARE I
FACILITY NUMBER: 374601468

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2026
Section Cited
CCR
87506(a)

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Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information. This requirement is not met as evidenced by:
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Licensee stated they will provide current resident records by POC due date.
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Based on record review, the licensee did not ensure 1 out of 5 [R5] residents records had a current resident appraisal and physician's report on file, which poses a potential health and safety, and personal rights risk to residents in care.
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Type B
10/13/2026
Section Cited
HSC1569.625(b)(2)

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Staff training; legislative findings; contents. In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.
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Licensee stated they will provide proof of current annual staff training by POC due date.
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This requirement is not met as evidenced by: Based on records review, the licensee did not ensure 8 out of 8 staff had current training on file, which posed a potential health and safety, and personal rights risk to 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.
Lizzette Tellez
NAME OF LICENSING PROGRAM MANAGER:
Natasha Persaud
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2026


LIC809 (FAS) - (06/04)
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