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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603323
Report Date: 05/26/2026
Date Signed: 05/26/2026 01:16:07 PM

Document Has Been Signed on 05/26/2026 01:16 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:BARON'S PRESIDIO UNIVERSITY CITYFACILITY NUMBER:
374603323
ADMINISTRATOR/
DIRECTOR:		NARMINA MAMEDOVAFACILITY TYPE:
740
ADDRESS:6860 CONDON DRIVETELEPHONE:
(858) 558-4772
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY: 6CENSUS: 4DATE:
05/26/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:31 AM
MET WITH:Administrator, Agnieszka NortonTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
NARRATIVE
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Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Deficiencies visit. LPA was greeted and allowed entry into the facility by Staff, Esther Villar and Administrator, Agnieszka Norton.

LPA was at the facility for an unrelated issue. During the visit, deficiencies were observed. The required postings were not posted. Residents bedding did not contain the required elements to include mattress pads and flat sheets. The administrator was not aware of required PPE items, LPA explained the required items to obtain. Bathroom #2 did not have a non-skid shower mat or strips. There was a camera in use, located in the kitchen. The administrator didn't know if audio was involved and was not aware of the requirements for video surveillance. The camera was removed during the visit and the administrator stated they will no longer use the camera. The front gate had a metal latching device which was not locked at the time but has potential to be locked with a padlock. LPA explained the law and the metal latching device was removed. The disaster drill was reviewed. The drills are not be conducting according to law. The administrator is the assigned lead for their infection control plan. However, the administrator has not received the required training and was not familiar with the infection control plan. The administrator was not familiar with the Emergency Disaster plan and required training protocols. Also, the facility sketch does not match the layout of the facility.

Deficiencies were observed and cited during the visit. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Agnieszka Norton whose signature below confirms receipt of these rights.
NAME OF LICENSING PROGRAM MANAGER: Lizzette Tellez
NAME OF LICENSING PROGRAM ANALYST: Natasha Persaud
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2026
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 5
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 05/26/2026 01:16 PM - It Cannot Be Edited


Created By: Natasha Persaud On 05/26/2026 at 11:45 AM
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: BARON'S PRESIDIO UNIVERSITY CITY
FACILITY NUMBER: 374603323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/04/2026
Section Cited
CCR
87468.1(a)(1)

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Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:
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The administrator was not aware if audio was being used. The camera was unplugged and removed. The administrator stated they will no longer use cameras. POC corrected.
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Based on interviews and observations, the licensee did not provide 4 out of 4 [R1-R4] residents with dignity by having a camera recording the residents without consent, which poses a potential personal rights risk to residents in care.
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Type B
06/04/2026
Section Cited
CCR87468(c)

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Personal Rights. Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. This requirement is not met as evidenced by:
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The administrator was not aware of the required postings. The administrator stated they will post all the required documentation by POC due date.
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Based on interviews and observations, the licensee did not post the required documentation for 4 out of 4 [R1-R4] residents, which poses a potential personal rights risk to 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.
Lizzette Tellez
NAME OF LICENSING PROGRAM MANAGER:
Natasha Persaud
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2026


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 05/26/2026 01:16 PM - It Cannot Be Edited


Created By: Natasha Persaud On 05/26/2026 at 12:02 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: BARON'S PRESIDIO UNIVERSITY CITY
FACILITY NUMBER: 374603323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/04/2026
Section Cited
HSC
87470(a)

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Infection Control Requirements. A licensee shall ensure that infection control practices are maintained as follows: This requirement is not met as evidenced by:
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The administrator was not aware of required PPE and training regarding infection control plan. The administrator stated they will obtain the required PPE and necessary training by POC due date
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Based on interviews and observations, the licensee did not obtain required training on their infection control plan and do not have required PPE for staff to assist with 4 out of 4 residents [R1-R4], which poses a potential health and safety risk to residents on care.
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Type B
06/04/2026
Section Cited
HSC1569.695(c)

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Emergency Plans. A facility shall conduct a drill at least quarterly for each shift. The type of emergency...vary from quarter to quarter...scenarios. An actual evacuation of residents is not required during a drill. 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 is not met as evidenced by:
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The administrator was not aware of various topics and documentation requirement. The administrator will conduct and document a disaster drill by the POC due date.
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Based on interviews and record review, the licensee did not conduct or document quarterly drills with various topics and requirements for 4 out of 4 [S1-S4] staff, which poses a potential health and safety risk to 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.
Lizzette Tellez
NAME OF LICENSING PROGRAM MANAGER:
Natasha Persaud
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/26/2026 01:16 PM - It Cannot Be Edited


Created By: Natasha Persaud On 05/26/2026 at 12:18 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: BARON'S PRESIDIO UNIVERSITY CITY
FACILITY NUMBER: 374603323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/04/2026
Section Cited
CCR
87307(a)(3)(C)

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Personal Accommodations and Services. Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited.
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The administrator was not aware of bedding requirements for residents. The administrator will ensure all bedding is appropriate to law by POC due date.
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Based on interviews and observations, the licensee did not have required bedding to include flat sheets and mattress pads on 4 out of 4 residents [R1-R4], which poses a potential health, safety and/or personal rights risk to residents in care.
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Type B
06/04/2026
Section Cited
CCR87208(a)(7)

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Plan of Operation. The licensee shall have... plan of operation for the facility. The licensee shall operate...1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. This requirement is not met as evidenced by:
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The administrator was not aware the facility sketch didn't match the layout of the facility and will submit a current updated sketch by POC due date.
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Based on interviews and observations, the licensee does not have a facility sketch that matches the actual floor plan of the facility for 4 out of 4 residents, which posed a potential health and safety risk to 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.
Lizzette Tellez
NAME OF LICENSING PROGRAM MANAGER:
Natasha Persaud
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2026


LIC809 (FAS) - (06/04)
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