374602737-9-10-2025-08-AS-MGCO-DLDVAX-20250910161640

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374602737
Report Date: 09/10/2025
Date Signed: 09/10/2025 04:16:58 PM

Document Has Been Signed on 09/10/2025 04:16 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:	PANGAN HOME 3		FACILITY NUMBER:	374602737
ADMINISTRATOR/ DIRECTOR:	PANGAN, JOSE V, JR		FACILITY TYPE:	735
ADDRESS:	4528 PACIFIC RIVIERA WAY		TELEPHONE:	(619) 428-2913
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92154
CAPACITY: 6		CENSUS: 5	DATE:	09/10/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:40 AM
MET WITH:	Caregiver, Victor		TIME VISIT/ INSPECTION COMPLETED:	12:10 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) Marisela Garcia-Centeno conducted an unannounced Required 1-Year Visit. Upon arrival, LPA was greeted by caregivers Victor Panlilio and Corazon Lopez, to whom she identified herself and explained the purpose of the visit. Administrator, Lisa Pangan arrived at the facility during the inspection. All staff present had current criminal record clearances. The licensee and two additional staff members maintained current administrator certificates on file. The facility is licensed for a maximum capacity of six (6) non-ambulatory developmentally disabled adults, ages 18–59. The license permits up to two (2) bedridden clients in bedroom #1 and authorizes care for restricted health conditions. At the time of the visit, five (5) clients were in care: three (3) non-ambulatory and one (1) bedridden client in bedroom #1. LPA, accompanied by caregiver Victor Panlilio, toured the interior and exterior of the facility. The facility was observed to be clean, sanitary, and in good repair. Pathways were free of obstructions and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were operational. Extra linens, hygiene supplies, and Personal Protective Equipment (PPE) were available. The facility had sufficient space and equipment for dining, laundry, visitation, meetings, and client activities. (Continue at LIC809C)

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Marisela Garcia-Centeno
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

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 3

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 3

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: PANGAN HOME 3	FACILITY NUMBER: 374602737
	VISIT DATE: 09/10/2025

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
26
27
28
29
30
31
32

(continue from LIC 809)

Food supplies met Title 22 requirements, with at least two (2) days of perishable food and seven (7) days of non-perishable food, all properly stored. Grocery shopping is conducted weekly. Cooking and dining equipment and utensils were present. No sharp objects, toxic chemicals/poisons, or open-faced heaters were accessible to clients. Medications were properly labeled and securely stored in locked areas.

The facility grounds contained no bodies of water. Per staff, no firearms or ammunition are stored on the premises. Smoke alarms, carbon monoxide detectors, emergency lighting, and the facility telephone were operational. One (1) fire extinguisher had been serviced within the past 12 months (April 2025). First aid kits were complete and accessible. Required licensing postings were displayed in visible areas. Room temperature was comfortable throughout the facility. All staff held current First Aid certificates. The facility conducts emergency drills as required; the most recent drill was conducted in August 2025. Monthly water temperature checks are performed by staff, with the last recorded reading at 110.1°F.

LPA interviewed staff and reviewed multiple staff and client files. All files contained the required documentation and confidential records were stored securely. Staff interviews revealed no licensing concerns.

No deficiencies were observed during today’s visit.

An exit interview was conducted with Administrator, Lisa Pangan, who was provided a copy of this report and the Licensee/Appeal Rights (LIC 9058 03/22).

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Marisela Garcia-Centeno
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

LIC809 (FAS) - (06/04)

Page: 3 of 3