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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603125
Report Date: 04/11/2025
Date Signed: 04/11/2025 04:31:11 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/26/2024 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20240826160702
FACILITY NAME:RANCHO SANTA FE VILLAFACILITY NUMBER:
374603125
ADMINISTRATOR:BAHA, RAY CYRUSFACILITY TYPE:
740
ADDRESS:8292 RUN OF THE KNOLLSTELEPHONE:
(858) 361-3322
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY:6CENSUS: 2DATE:
04/11/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Ray BahaTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility had uncleared staff.
Required postings were not visible.
Facility did not conduct emergency drills
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced complaint investigation visit and delivered complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Caregiver Weny Labuguin. Administrator Ray Baha arrived during the visit and assisted the LPA.

Throughout the investigation, the Department secured pertinent records and conducted interviews with external and internal sources, including staff and residents.

It was alleged the facility had uncleared staff. On August 26th, 2024, it was reported to the Department the facility had hired Staff # 1 (S1), but S1 was not background cleared to work at the facility.
Interviews with internal and external sources revealed S1 was a private caregiver providing services to a resident at the facility.

(See LIC 9099-C for continuation of report.)
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 08-AS-20240826160702
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: RANCHO SANTA FE VILLA
FACILITY NUMBER: 374603125
VISIT DATE: 04/11/2025
NARRATIVE
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These interviews, including the administrator and S1, corroborated S1 was asked to work for the facility for two days, while regular care staff were off. Review of the Department’s background clearance database revealed S1 was not associated to the facility and did not have a background clearance. Based on the evidence obtained, the deficiency was cited in an LIC 9099-D form. An immediate two hundred dollar ($200) civil penalty was assessed in an LIC 421BG form.

It was alleged required postings were not visible. It was reported to the Department the required postings, including the Department’s “If you see something, Say something” poster, were posted in a section of the facility the residents did not use. Interviews with staff, including the administrator, confirmed the section of the facility where the postings were was not regularly used by residents. The area was used for meetings. The LPA observed some of the postings were not visible. The deficiency was cited in an LIC 9099-D form.

It was alleged the facility did not conduct emergency drills. It was reported to the Department residents had not participated in emergency drills. Interviews with several staff revealed the facility conducted drills every three months. The type of drills varied between fire, and earthquake emergencies. Review of records revealed the facility documented the date of the drill, and staff who participated, but not the time. An interview with the administrator revealed the facility did not conduct drills on every scheduled shift. Per regulations, the residents are not required to participate in emergency drills, but the facility must conduct drills at least quarterly for each shift. This deficiency was cited in an LIC 9099-D form.

Plans of Corrections (POCs) were jointly formulated with Administrator Baha.

An exit interview was conducted with Baha, to whom a copy of this report, LIC 9099D forms, LIC 421BG, LIC 811, and Licensee/Appeals Rights (LIC 9058), were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20240826160702
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: RANCHO SANTA FE VILLA
FACILITY NUMBER: 374603125
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/11/2025
Section Cited
CCR
87355(e)(2)
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87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department... This requirement was not met as evidenced by:
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Administrator agreed to obtain criminal records clearances for all new staff. Administrator stated S1 no longer worked at the facility. The LPA did not observe S1 at the facility, therefore, the POC was cleared on today's date.
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Based on interviews, and review of records, the Licensee did not ensure S1 had a criminal records clearance, which posed an immediate health, safety, and personal rights risk to 4 residents in care.
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S1 was background cleared and associated after, 9/4/2024.
Type B
04/11/2025
Section Cited
CCR
87468.2(a)(10)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(10)...regarding grievances in regard to the licensee. The licensee shall post the telephone numbers and addresses for the local offices of the State Department of Social Services and ombudsman program, according to Section 9718 of the Welfare and Institutions Code, conspicuously in the facility foyer, lobby, residents’ activity room, or other location easily accessible to residents and their representatives. This requirement was not met as evidenced by:
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Administrator agreed to post required postings in a hallway where they are visible to all residents, by 5/2/25.
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Based on interviews and observations, the Licenssee did not ensure these postings were conspicuously posted where residents could see them, which posed a potential health, safety and personal rights risk to 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.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20240826160702
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: RANCHO SANTA FE VILLA
FACILITY NUMBER: 374603125
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/11/2025
Section Cited
HSC
1569.695(c)
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§1569.695 Emergency Plans (c) 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, taking into account different emergency scenarios. An actual evacuation of residents is notrequired during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement was not met as evidenced by:
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Administrator agreed to conduct an emergency drill during each shift and submit proof to the LPA by 5/2/25.
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Based on review of records and interviews, the Licensee did not ensure emergency drills were conducted for each shift, which posed a potential health, safety, and personal rights risk to 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.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5