374604227-5-5-2026-08-AS-AGOH-DTSUKR-20260505153930

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604227
Report Date: 05/05/2026
Date Signed: 05/05/2026 03:39:40 PM

Document Has Been Signed on 05/05/2026 03:39 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:	SUMMERFIELD OF ENCINITAS		FACILITY NUMBER:	374604227
ADMINISTRATOR/ DIRECTOR:	MARGRITZ, MERCEDES		FACILITY TYPE:	740
ADDRESS:	1350 S. EL CAMINO REAL		TELEPHONE:	(760) 479-1818
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY: 56		CENSUS: 43	DATE:	05/05/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Executive Director Mercedes Margritz and Business Office Manager Emerald Jordan		TIME VISIT/ INSPECTION COMPLETED:	12:15 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 Case Management visit to follow up on an incident reported to Community Care Licensing (CCL). LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Executive Director Mercedes Margritz and Business Office Manager Emerald Jordan. Community Care Licensing received a SOC 341 report from an outside source on 4/29/26 in which it was reported that a resident (Identified as R1) had been admitted to the hospital for rectal bleeding. Per the report, R1 had reported the bleeding was caused by having consensual sex with another resident at the facility. During the encounter, R1 then indicated they wished to stop and the other resident did not stop until the second time R1 had asked. R1 is diagnosed with Dementia. During today's visit, LPA conducted file review and interviews, and provided consultation with Executive Director Margritz. Law enforcement had been contacted regarding the incident and per their investigation, R1's statement of event dates and details would rapidly change and they would name different residents at the facility or mix names of multiple residents. Additionally, per review of R1's records and interviews with staff, R1 has had ongoing rectal bleeding for a span of several weeks. R1's records indicate a history of a medical condition that causes rectal bleeding. On 4/15/26, R1's responsible party had brought up to facility staff that R1 shared to to them that R1 had a consensual sexual encounter with another resident which turned into anal penetration and resulted in rectal bleeding. [Continued on LIC 809-C]

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Arian Golbakhsh
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)

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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: SUMMERFIELD OF ENCINITAS	FACILITY NUMBER: 374604227
	VISIT DATE: 05/05/2026

NARRATIVE

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[Continued from LIC 809]

During another episode of rectal bleeding on 4/29/26, R1's responsible party then took R1 to the hospital to be evaluated. R1 returned the next day with new medication orders for pain management.

Based on interviews and file review, the facility had been made aware of R1's sexual encounter on 4/15/26 and CCL had not received any notification of the incident within the required seven (7) days. A Type B deficiency for not meeting reporting requirements was issued, and details are included on the attached LIC 809-D page. Interviews with staff indicated the facility had implemented increased routine checks on R1 since their return from the hospital. LPA attempted to interview R1 during their visit, however R1 was being assisted with showering.

One deficiency was cited during today's visit. An exit interview was conducted with Executive Director Margritz to whom a copy of this report 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: 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

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/05/2026 03:39 PM - It Cannot Be Edited

Created By: Arian Golbakhsh On 05/05/2026 at 01:33 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: SUMMERFIELD OF ENCINITAS	FACILITY NUMBER: 374604227
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/05/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/12/2026 Section Cited CCR 87211(a)(1)	1 2 3 4 5 6 7	87211(a):Each licensee shall furnish to the licensing agency [...] (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below [...]." This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee submitted an incident report to the Department. Licensee will review regulation 87211 and submit to LPA by the POC due date the facility's plan to ensure ongoing compliance with reporting timelines moving forward
	8 9 10 11 12 13 14	Based on LPA file review and interview, the licensee did not comply with the section cited above in meeting timelines for reporting requirements, which poses a potential health, safety, and personal rights risk to all persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 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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