<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602023
Report Date: 08/31/2026
Date Signed: 08/31/2026 12:39:12 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/31/2026 12:39 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:PASCUA RCFEFACILITY NUMBER:
374602023
ADMINISTRATOR/
DIRECTOR:		JESUSA PASCUAFACILITY TYPE:
740
ADDRESS:1268 STAMEN STTELEPHONE:
(619) 266-0209
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 4CENSUS: 3DATE:
08/31/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA's) Amy rodgers and Patrice Bazemore conducted an unannounced Required Annual Inspection. The LPA introduced themselves and disclosed the purpose of the visit to care staff Maureen Lanada. Jesusa Pascua joined the visit shortly after. According to the facility’s license, there may be a maximum of four (4) residents two (2) of whom may be non-ambulatory in at any given time at the facility site.

Accompanied by staff, the LPA toured the facility The exterior patio was clean, pathways were free of obstructions and trip hazards, and gates were unlocked. Doors, windows, screens, toilets, and showers were in working order. Resident bedrooms contained the required furnishings, and the facility had sufficient space and equipment to facilitate dining, laundry, visitation, and meetings. No pools, nor bodies of water were observed on the premises. A fireplace in the living room area was witnessed to not a have a screen. A carbon monoxide detector, facility telephone, and fire extinguisher were present and operational. Required licensing postings were observed in visible areas of the facility. 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 no toxic chemicals/poisons accessible to residents.
Medications were labeled, and stored in a locked area.

The LPA interviewed staff and reviewed multiple staff and resident records however some records were missing information. Deficiencies observed were cited in an LIC 809D form. Plans of correction were jointly formulated with Licensee/Administrator Jesusa Pascua

An exit interview was conducted with Licensee/Administrator Jesusa Pascua, to whom a copy of this report, LIC 809D forms, LIC 859, and the Licensee/Appeal Rights (LIC9058), were provided.
Simon Jacob
Amy Rodgers
DATE: 08/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2026
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 4
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)
Page: 2 of 4
Document Has Been Signed on 08/31/2026 12:39 PM - It Cannot Be Edited


Created By: Amy Rodgers On 08/31/2026 at 12:03 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: PASCUA RCFE
FACILITY NUMBER: 374602023

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2026
Section Cited
HSC
15769.618(c)(3)

1
2
3
4
5
6
7
3) Ensure that at least one staff member who has..(CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR.
This requirement is not met as evidenced by:

1
2
3
4
5
6
7
Licencee agreed to obatin CPR training for S1- S3, and submit them to the LPA, by 10/01/2026.

8
9
10
11
12
13
14
Based on review of records, the licensee did not comply with the section cited above in which licensee did not obtain CPR (S1-S3) which posed a potential health, safety or personal rights risk to 3 persons in care.
8
9
10
11
12
13
14
Type B
10/01/2026
Section Cited
CCR87411(f)

1
2
3
4
5
6
7
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure...
1
2
3
4
5
6
7
Licencee agreed to obatin TB testing for S1- S3, and submit them to the LPA, by 10/01/2026.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:

Based on review of records, the licensee did not comply with the section cited above in which licensee did not obtain TB test (S1-S3) which posed a potential health, safety or personal rights risk to 3 persons in care.
8
9
10
11
12
13
14
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:
Amy Rodgers
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/31/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2026


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/31/2026 12:39 PM - It Cannot Be Edited


Created By: Amy Rodgers On 08/31/2026 at 12:15 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: PASCUA RCFE
FACILITY NUMBER: 374602023

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2026
Section Cited
CCR
87412(a)(11)

1
2
3
4
5
6
7
(11) A health screening as specified in Section 87411, Personnel Requirements - General.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licencee agreed to obatin required health screenings for S1 and S2, and submit them to the LPA, by 10/01/2026.
8
9
10
11
12
13
14
Based on review of records, the licensee did not comply with the section cited above in 2 out 5 staff did not obtain a health screening (S1 and S2) which posed a potential health, safety or personal rights risk to 3 persons in care.
8
9
10
11
12
13
14
Type B
10/01/2026
Section Cited
CCR87412(c)(1)

1
2
3
4
5
6
7
(c) Licensees shall maintain in the personnel records verification of required staff training and orientation.
(1) The following staff training and orientation shall be documented:
This requirement is not met as evidenced by:


1
2
3
4
5
6
7
Licencee agreed to obatin required trainings for S1- S3, and submit them to the LPA, by 10/01/2026.
8
9
10
11
12
13
14
Based on review of records, the licensee did not comply with the section cited above in 3 out 5 staff did not obtain required trainings (S1-S3) which posed a potential health, safety or personal rights risk to 3 persons in care.
8
9
10
11
12
13
14
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:
Amy Rodgers
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/31/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2026


LIC809 (FAS) - (06/04)
Page: 4 of 4