374603125-4-27-2026-08-AS-AGOH-DTK34V-20260427175546

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603125
Report Date: 04/27/2026
Date Signed: 04/27/2026 05:56:08 PM

Document Has Been Signed on 04/27/2026 05:56 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:	RANCHO SANTA FE VILLA		FACILITY NUMBER:	374603125
ADMINISTRATOR/ DIRECTOR:	BAHA, RAY CYRUS		FACILITY TYPE:	740
ADDRESS:	8292 RUN OF THE KNOLLS		TELEPHONE:	(858) 361-3322
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92127
CAPACITY: 6		CENSUS: 4	DATE:	04/27/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Caregivers Weny Labuguin and Angelita Hernandez. Administrator Mohammad "Ray" Baha		TIME VISIT/ INSPECTION COMPLETED:	06:05 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) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregivers Weny Labuguin and Angelita Hernandez. Administrator Ray Baha arrived shortly after LPA. The facility's license shows a maximum capacity of six (6) non-ambulatory residents. Bedrooms #1, #4, #5, and #6 are approved for bedridden. Additionally, the facility is approved for a hospice waiver for six (6). During today’s inspection there were four (4) residents in care, with none currently on hospice. Note, LPA did step out from 12:50-1:50 for lunch. LPA and Administrator Baha toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: common bathroom sink adjacent to bedroom #7 was 107.2F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and inaccessible to residents. While looking at the unlocked cabinet under the sink, LPA observed a number of cleaning chemicals. One type A deficiency was issued for the accessible chemicals to residents. Staff immediately moved the items to a locked storage room. [Continued on LIC 809-C]

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Arian Golbakhsh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

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: RANCHO SANTA FE VILLA	FACILITY NUMBER: 374603125
	VISIT DATE: 04/27/2026

NARRATIVE

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[Continued from LIC 809]

Additionally, while touring the enclosed courtyard at the center of the home, LPA was shown the doorway to the garage area. LPA observed that the door was only lockable from the inside and was currently unlocked. Inside the garage were a number of chemicals, in addition to an accessible door into the medication/chemicals storage room. Per Administrator Baha, the facility was in the process of changing several locks (garage door included) in the home so that they are all accessible by the same key for efficiency. Administrator Baha locked the doorway from the inside and exited through the lifting garage door so that the garage was no longer accessible to residents.

LPA observed that the doors to the enclosed courtyard space were unlocked, allowing for resident access. However, the exterior doors of the home leading outside were all locked aside from the front door and required a key to open. The facility does not have approval for locked exterior doors and/or a locked perimeter. Administrator Baha explained that the exterior yard is not safe for resident use and the enclosed courtyard is the designated outdoor space for resident use. One type A deficiency was cited for the unapproved locked exterior doors.

Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator Baha, no firearms or ammunition are kept at the facility. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months, dated for February 2026. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA observed a private care aid (identified as S1) who was present at the facility for their assigned resident (identified as R1). LPA requested S1's background clearance from the facility for review and was informed that they did not have it on file. Per interview with S1, it was revealed S1 was not employed by a private care agency. Upon review of the Guardian background check database, it was revealed that S1 had not undergone the LiveScan process (fingerprint submittal and background check). One Type A deficiency was issued for S1 providing care and supervision services on the premises without a required background check. LPA ensured S1 was escorted off the premises.

[Continued on LIC 809-C]

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Arian Golbakhsh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

LIC809 (FAS) - (06/04)

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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: RANCHO SANTA FE VILLA	FACILITY NUMBER: 374603125
	VISIT DATE: 04/27/2026

NARRATIVE

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[Continued from LIC 809-C]

While at the facility, LPA observed five (5) camera monitor systems displaying common facility areas and the inside of four (4) resident rooms, along with audio from each space. Per Administrator Baha, the responsible parties of the residents were aware of the use of cameras in private spaces and gave permission. While the use of surveillance cameras are not expressly prohibited in Title 22 regulations, efforts to protect resident privacy must be maintained by the facility and a waiver request must be submitted to the Department for camera use in private resident rooms. An audio component for video surveillance in facilities is strictly prohibited. One Type B citation was issued for the use of video and audio surveillance in private areas of the facility without Department approval. Administrator Baha turned off all five monitors.

LPA interviewed two (2) staff and one (1) clients, and interviews did not reveal any additional licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. LPA noted consent forms signed by resident responsible parties included in the files of only three (3) of the four (4) resident rooms that contained cameras.

Four (4) deficiencies were cited during the inspection. An exit interview was conducted with Administrator Baha to whom a copy of this report, the LIC 421BG form, and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Arian Golbakhsh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/27/2026 05:56 PM - It Cannot Be Edited

Created By: Arian Golbakhsh On 04/27/2026 at 03:26 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: RANCHO SANTA FE VILLA	FACILITY NUMBER: 374603125
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87705(f)

Care of Persons with Dementia

(f) Licensees that lock exterior doors or perimeter fence gates shall meet the following initial and continuing requirements: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation and interview, the licensee did not comply with the section cited above in meeting the requirements outlined in regulation 87705(f) for locking exterior doors, which poses an immediate health, safety, and personal rights risk to all persons in care.
	POC Due Date: 05/25/2026
	Plan of Correction
1 2 3 4	Licensee immediately unlocked all exterior doors of the home to allow resident access. Licensee will reach out to the fire marshal to see if any modifications need to be done in regards to requesting to have locked exterior doors, then Licensee will submit request to CCL for approval to have locked exterior doors.

Type A

Section Cited

CCR

87309(a)

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items 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:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation and interview, the licensee did not comply with the section cited above in ensuring that toxic chemicals were kept in secured storage and inaccessible to residents, which poses an immediate health and safety risk to all persons in care.
	POC Due Date: 05/11/2026
	Plan of Correction
1 2 3 4	Staff immediately moved the chemical items from under the sink to a locked storage room. Staff locked the access door to the garage from the enclosed courtyard. Licensee will conduct review/retraining with staff on regulation 87309 regarding the procedures for toxic/dangerous items storage and submit proof to LPA by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:

	Arian Golbakhsh
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/27/2026 05:56 PM - It Cannot Be Edited

Created By: Arian Golbakhsh On 04/27/2026 at 03:44 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: RANCHO SANTA FE VILLA	FACILITY NUMBER: 374603125
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87355(e)(2)

87355(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 is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation and interview, the licensee did not comply with the section cited above in ensuring a private care aid (identified as S1) had an eligible background clearance prior to being present at and performing care for a resident at the facility, which poses an immediate health and safety risk to all persons in care.
	POC Due Date: 04/28/2026
	Plan of Correction
1 2 3 4	LPA ensured S1 was escorted off the property. Licensee will submit receipt of S1 having submitted their fingerprints for a background check to LPA by POC due date. Licensee is aware that S1 may not be present at the facility until receipt of S1's approved/eligible background clearance.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:

	Arian Golbakhsh
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

LIC809 (FAS) - (06/04)

Page: 6 of 7

Document Has Been Signed on 04/27/2026 05:56 PM - It Cannot Be Edited

Created By: Arian Golbakhsh On 04/27/2026 at 03:52 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: RANCHO SANTA FE VILLA	FACILITY NUMBER: 374603125
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87468.2(a)(1)

(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:(1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation, file review, and interview, the licensee did not comply with the section cited above in ensuring reasonal privacy was afforded for residents due to the use of unapproved camera and audio surveillance in private resident rooms, which poses a potential personal rights risk to persons in care.
	POC Due Date: 04/28/2026
	Plan of Correction
1 2 3 4	Licensee turned off the camera/audio monitors placed in resident rooms. Licensee will submit a waiver request to the Department for permission to use cameras in resident rooms by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:

	Arian Golbakhsh
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

LIC809 (FAS) - (06/04)

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