<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604544
Report Date: 08/06/2026
Date Signed: 08/06/2026 06:33:28 PM

Document Has Been Signed on 08/06/2026 06:33 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:BONITA VILLA SENIOR LIVINGFACILITY NUMBER:
374604544
ADMINISTRATOR/
DIRECTOR:		REBECCA TOVESFACILITY TYPE:
740
ADDRESS:3434 BONITA ROADTELEPHONE:
(619) 476-9444
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 145CENSUS: 84DATE:
08/06/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Executive Director Amber RodgersTIME VISIT/
INSPECTION COMPLETED:
06:40 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 the facility. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Executive Director Amber Rodgers.

As LPA was conducting interviews with residents and outside sources, it was revealed to LPA that a resident (identified as R1) was not having their care needs met by facility staff. Interview with R1 revealed that staff bring R1 three (3) meals a day, however R1 has not been receiving assistance with eating, which they need. Interviews with two (2) outside source individuals managing R1's care also shared concerns about R1 not receiving needed feeding assistance, often arriving to find R1 hungry. One outside source interviewed corroborated that R1 is physically unable to feed themselves. Another who was interviewed shared that from their understanding, facility services for R1's level of care do not include feeding assistance.

File review of R1's Physician's Assessment dated for October 2023 list R1 as able to feed themselves and staff later brought LPA a copy of R1's updated physician assessment dated for June 2026 -- that the facility had received today, which noted R1 as unable to feed themselves. Review of R1's current service plan, dated for July 2026 indicate R1 is independent in feeding. Review of R1's service plan prior to the current one is dated for December 2024 and also noted R1 to be independent in feeding. One type A Deficiency is being cited per California Code of Regulations, Title 22, Division 6 on the attached LIC 809-D for the facility's neglect in meeting R1's feeding assistance needs. This violation was previously cited within a 12 month period on 12/22/2025, constituting for a Repeat Violation Civil Penalty of $1,000.00. An additional Type A deficiency is being cited for the facility not obtaining or requesting an updated medical assessment on an annual basis or as needed with changes in resident condition. This violation was previously cited within a 12 month period on 4/27/2026, constituting for a Repeat Violation Civil Penalty of $1,000.00.

[Continued on LIC 809-C]
Sabel Martinez
Arian Golbakhsh
DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2026
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)
Page: 2 of 5
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: BONITA VILLA SENIOR LIVING
FACILITY NUMBER: 374604544
VISIT DATE: 08/06/2026
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
26
27
28
29
30
31
32
[Continued from LIC 809]

Additionally, R1 shared that they have not been receiving routine repositioning as they are bedridden, especially during the night. Per R1, they are a two (2) person assist for repositioning, but there is only one staff member assigned to the area overnight and so the staff will not try. Per review of R1's Physician's Assessment, dated October 2023, R1 does not require continuous bed care or have a history of skin conditions/breakdown. However, per interview with a member of R1's hospice team, R1 has been bedridden since starting hospice services and is currently receiving wound care services for a pressure injury sustained to the coccyx (tailbone area). The facility was able to provide an updated physician's assessment dated for June 2026, and it does indicate R1 of requiring assistance with repositioning and that R1 is noted to have a history of skin condition and breakdown. Review of R1's service plan dated revealed for July 2026 does not address repositioning needs for R1 at all. One type A Deficiency is being cited per California Code of Regulations, Title 22, Division 6 on the attached LIC 809-D for the facility not meeting R1's repositioning needs. This violation was previously cited within a 12 month period on 4/27/2026, constituting for a Repeat Violation Civil Penalty of $1,000.00.

While at the facility, LPA also made requests for additional resident and staffing records and the facility was unable to provide them during the duration of LPA's visit. One type A Deficiency is being cited per California Code of Regulations, Title 22, Division 6 on the attached LIC 809-D for the facility not being able to furnish records as required for LPA to review during normal business hours. This violation was previously cited within a 12 month period on 4/15/2026, constituting for a Repeat Violation Civil Penalty of $1,000.00.

Four deficiencies were cited during the inspection for a total of $4,000.00. Additional Civil Penalties are under review by the Community Care Licensing Division (CCL) and may be assessed at a later date. An exit interview was conducted with Executive Director Rodgers 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: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 08/06/2026 06:33 PM - It Cannot Be Edited


Created By: Arian Golbakhsh On 08/06/2026 at 03:48 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: BONITA VILLA SENIOR LIVING
FACILITY NUMBER: 374604544

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/07/2026
Section Cited
CCR
87468.2(a)(4)

1
2
3
4
5
6
7
87468.2: "In addition to the rights listed in Section 87468.1 [...] residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(4) To care, supervision, and services that meet their individual needs [...]."
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will conduct a reappraisal/redo the service plan for R1 that addresses and meets their current service needs. Licensee will submit proof to LPA by POC due date.
8
9
10
11
12
13
14
Based on interviews and file review, the licensee did not comply with the section cited above in ensuring a resident's needs for feeding assistance were met, which poses an immediate health and safety risk to 1 out of 84 persons in care.
8
9
10
11
12
13
14
Type A
08/07/2026
Section Cited
CCR87458(b)

1
2
3
4
5
6
7
87458(b): "The licensee shall obtain an updated medical assessment when required by the Department."

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee obtained an updated medical assessment for R1. Licensee will conduct review of all resident files to ensure that each has a current/updated medical assessment as needed. Licensee will submit proof to LPA by POC due date.
8
9
10
11
12
13
14
Based on interviews and file review, the licensee did not comply with the section cited above in ensuring an updated medical assessment was obtained as necessary for R1, which posed an immediate health and safety risk to 1 out of 84 persons in care.
8
9
10
11
12
13
14
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: 08/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2026


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 08/06/2026 06:33 PM - It Cannot Be Edited


Created By: Arian Golbakhsh On 08/06/2026 at 04:47 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: BONITA VILLA SENIOR LIVING
FACILITY NUMBER: 374604544

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/07/2026
Section Cited
CCR
87101(c)(3)

1
2
3
4
5
6
7
87101(c)(3): '"Care and Supervision" [...] involves assistance as needed with activities of daily living and the assumption of varying degrees of responsibility for the safety and well-being of residents. [...]."

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will conduct review of R1's care plan in collaboration with R1's hospice team and update as necessary to reflect current care needs. Additionally, Licensee will coordinate an in-service training with staff on bedridden care. Licensee will submit proof to LPA by POC due date.
8
9
10
11
12
13
14
Based on interviews and file review, the licensee did not comply with the section cited above in ensuring bedridden care and supervision needs for R1 were met as necessary, which posed an immediate health and safety risk to 1 out of 84 persons in care.
8
9
10
11
12
13
14
Type A
08/07/2026
Section Cited
CCR87412(f)

1
2
3
4
5
6
7
87412(f): "All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. [...]."

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will submit requested staff records to LPA by POC due date.
8
9
10
11
12
13
14
Based on interviews and file review, the licensee did not comply with the section cited above in being able to provide staff records for review, which posed an immediate health and safety risk to all persons in care.
8
9
10
11
12
13
14
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: 08/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2026


LIC809 (FAS) - (06/04)
Page: 5 of 5