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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602797
Report Date: 05/05/2026
Date Signed: 05/05/2026 04:42:35 PM

Document Has Been Signed on 05/05/2026 04:42 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ELITE MANOR RESIDENTIAL CAREFACILITY NUMBER:
374602797
ADMINISTRATOR/
DIRECTOR:		I. CHEN LEEFACILITY TYPE:
740
ADDRESS:1433 FERRARA COURTTELEPHONE:
(858) 729-3786
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 6CENSUS: 4DATE:
05/05/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:William Lee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
NARRATIVE
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Licensing Program Analyst (LPA), Robert Campbell conducted a case management visit to the facility for the purpose of issuing deficiencies related to Annual Inspection on 4/20/2026. LPA Robert met with Emelinda Tuazon - Caregiver and explained the purpose of the visit and assisted LPA. LPA spoke with William Lee - Administrator over the phone to explain the purpose of the visit. William Lee/Administrator came to the facility later during the visit.

LPA toured the facility, observed, took pictures of the following physical environment Type A deficiencies, Resident#4 six (6) medications (photos taken of each medication) was unlocked in kitchen cabinet by oven the same place as the Annual on 4/20/2026, Resident#2 in Room #2 had three (3) medications unlocked sitting on the dresser (photos taken by LPA), three (3) toxins were unlocked in the kitchen under the sink cabinet (lock was broken), bathroom#1 two (2) toxins unlocked again (same as Annual on 4/20/2026) under the sink cabinet, bathroom#2 two (2) toxins (photos taken) unlocked in cabinet below sink. LPA observed three structures (LPA took photos) with staff personal belongings stored and beds not on the facility sketch and has no fire clearance. Facility will review deficiencies on the 809D document. Civil penalties will be assessed for repeated deficiencies.

LPA during interviews of Administrator, two Staff, Resident#4 was in the living room in a gerry chair as a restraint with no exception from Community Care Licensing which is a personal rights violation.LPA will cite the facility with a Type A deficiency of violating the personal rights of Resident#4. Facility will review deficiency on the 809D document.



An exit interview was conducted, and this report was discussed and provided to William Lee - Administrator.
NAME OF LICENSING PROGRAM MANAGER: Jazmond D Harris
NAME OF LICENSING PROGRAM ANALYST: Robert Campbell
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2026
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)
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Document Has Been Signed on 05/05/2026 04:42 PM - It Cannot Be Edited


Created By: Robert Campbell On 05/05/2026 at 03:19 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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ELITE MANOR RESIDENTIAL CARE
FACILITY NUMBER: 374602797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/06/2026
Section Cited
CCR
87309(a)(b)

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The licensee shall ensure that disinfectants, cleaning solutions, poisonous substances....which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:
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LPA observed staff locking all toxins at time of visit. Licensee will have a contractor come out to the facility to install another lock in the kitchen cabinet under the sink by 5/15/2026. Licensee will have comprehensive training on locking toxins with material and sign in sheet by POC
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LPA observed three (3) toxins were unlocked in the kitchen under the sink cabinet (lock was broken), bathroom#1 two (2) toxins unlocked again (same as Annual on 4/20/2026) under the sink cabinet, bathroom#2 two (2) toxins (photos taken) unlocked in cabinet below sink.
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Type A
05/06/2026
Section Cited
CCR87465(h)(2)

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(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible....medication. This requirement is not met as evidenced by:
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LPA observed staff lock medication at time of visit. Licensee will have a licensed professional train all staff on medication storage and administration by 5/19/2026
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LPA observed Resident#4 six (6) medications (photos taken of each medication) was unlocked in kitchen cabinet by oven the same place as the Annual on 4/20/2026, Resident#2 in Room #2 had three (3) medications unlocked sitting on the dresser (photos taken by LPA)
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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.
Jazmond D Harris
NAME OF LICENSING PROGRAM MANAGER:
Robert Campbell
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/05/2026 04:42 PM - It Cannot Be Edited


Created By: Robert Campbell On 05/05/2026 at 03:32 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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ELITE MANOR RESIDENTIAL CARE
FACILITY NUMBER: 374602797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/06/2026
Section Cited
CCR
87468.1(a)(6)

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(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(6)To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement is not met as evidenced by:
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LPA observed resident#4 released from the gerry chair at time of visit. Licensee will have PCP write a order for use of gerry chair as restraint and submit a letter of exception to Licensing agency by 5/15/2026. All staff will have a training on personal rights with material and sign in sheet by 5/15/2026
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LPA during visit had interviews with the Administrator, two Staff, Resident#4 was in the living room in a gerry chair as a restraint with no exception.
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Type B
06/02/2026
Section Cited
CCR87305(a)(b)

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(a) Prior to construction or alterations, all facilities shall obtain a building permit.(b) The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists.This requirement is not met as evidenced by:
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Licensee will have the city zoning department and city fire department visit facility to inspect added structures and submit clearance letters by POC date.
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LPA observed three structures (LPA took photos) with staff personal belongings stored and beds not on the facility sketch and does not have approval from Licensingand has no fire clearance.
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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.
Jazmond D Harris
NAME OF LICENSING PROGRAM MANAGER:
Robert Campbell
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
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