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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602179
Report Date: 10/20/2025
Date Signed: 10/20/2025 04:32:59 PM

Document Has Been Signed on 10/20/2025 04:32 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:TENDER LOVING CARE GUEST HOMEFACILITY NUMBER:
374602179
ADMINISTRATOR/
DIRECTOR:		VICTORIA S. LEGASPIFACILITY TYPE:
740
ADDRESS:1430 SHERYL LNTELEPHONE:
(619) 399-3552
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 6CENSUS: 5DATE:
10/20/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Victoria Legaspi, TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst’s (LPA’s) Carmen Lopez and Jose De La Cruz conducted an unannounced required annual inspection and, in conjunction conducted this case management visit for a Plan of Correction (POC) clearances. LPA Lopez and De La Cruz identified themselves and were granted entry by Licensee Victoria Legaspi. LPA's met with Licensee Legaspi and discussed the purpose of today’s visit.

During today’s visit, LPA’s Lopez and De la Cruz spoke with the Licensee Legaspi. According to licensee Legaspi, none of the pending POCs have been corrected with the exception of one. On 10/20/25, LPA Lopez reissued a citation that was cleared during today’s visit for CCR Section 87468.1 (a)(1) Personal Rights of Residents in all Facilities, that was issued on 08/25/25. This is deemed cleared during today’s visit.

The following deficiencies were formerly issued and have continued as civil penalties for the following uncleared deficiencies:

On 05/19/2025, Licensee was issued a citation for Plan of Operations and Reporting Requirements. During today’s visit, the Licensee was unable to produce the documents to clear the citations and civil penalties have been assessed.

On 04/24/2025, licensee Legaspi was issued citations for staff training for resident Bill of Rights, Resident Records, Evaluation of Suitability for Admission, Basic Services, Finances, and Health and Safety Code (HSC) for quarterly fire drill, and evacuation chair, and deficiencies were discussed with the Licensee. LPA’s Lopez and De La Cruz confirmed the deficiencies have yet to be cleared and civil penalties will continue to accrue. A failure to correct was issued for each of the deficiencies.

(Continuation on LIC809-C)
NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2025
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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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: TENDER LOVING CARE GUEST HOME
FACILITY NUMBER: 374602179
VISIT DATE: 10/20/2025
NARRATIVE
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(Continuation of LIC809)

On 04/17/2025, the Licensee was issued a Type A deficiency regarding false/misleading statements. On 08/25/2025, Licensee was unable to produce the POC to clear the deficiency. During today’s visit, the Licensee was still unable to produce the POC, and a failure to correct was issued for the continued deficiency.

On 10/28/2024, licensee Legaspi was issued citations that continued to civil penalties up to date for resident reappraisals, client #1 (C1’s), Personnel Records for staff #1 (S1) and Administrator’s certificate as licensee Legaspi was unable to produce the clearance. Civil Penalties continue to accrue for these citations issued on 10/28/2024. Also, on today's date licensee will be issued a repeat violation for resident records - specifically Physician's Report (LIC602) on their required annual inspection.

On 12/05/2024 and 12/06/2024, the Licensee was issued civil penalties for a visit conducted on 10/28/24, for Personnel Records, Resident Records, and reappraisals. During today's visit, the Licensee was issued civil penalties as the deficiencies issued on 12/05/2024 and 12/06/2024 have yet to be corrected.

During today's visit, LPAs did leave the facility to write their reports and returned to deliver their findings regarding today's visit.

An exit interview was conducted, a copy of the Failure to Correct/Civil Penalties, and a copy of this report, along with Licensee Rights (LIC 9058 03/22) were provided to licensee Victoria Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.
NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/20/2025 04:33 PM - It Cannot Be Edited


Created By: Carmen Lopez On 10/20/2025 at 02:34 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: TENDER LOVING CARE GUEST HOME
FACILITY NUMBER: 374602179

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/24/2025
Section Cited
CCR
87468.1(a)(1)

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87468.1 (a)(1) Personal Rights of Residents in all Facilities: To be accorded dignity in their personal relationships with staff, residents, and other persons... This was not met as evidence by:
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Licensee agreed to move one of the residents to a different room to ensure the incident is not repeated by POC due 5/30/25, but both clients agreed to stay as roommates. As such the POC was re-evaluated and residents signed an agreement which was completed during today’s visit and deemed cleared.
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Based on interviews with residents and staff, staff did not address the indecent exposure incident for 2 of 4 residents in care when they were informed which posed a potential personal rights risk to 2 of 4 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.
Robyn Clark
NAME OF LICENSING PROGRAM MANAGER:
Carmen Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2025


LIC809 (FAS) - (06/04)
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