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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604544
Report Date: 08/08/2026
Date Signed: 08/08/2026 03:11:25 PM

Document Has Been Signed on 08/08/2026 03:11 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: 98DATE:
08/08/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:30 AM
MET WITH:Amber Rodgers, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
11:45 PM
NARRATIVE
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Licensing Program Analyst's (LPA's) Amy Rodgers and Amy Domingo conducted an unannounced Health and Safety Checks visit regarding a deficiency that was cited on 8/4/26. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit Xitlali Esquivel, Med Tech. The Executive Director, Amber Rodgers and RSD Eva Zuluaga also participated in the meeting.

On 8/4/26 the facility was issued a deficiency for accepting and/or retaining bedridden residents without having a fire clearance that allows so. A Plan Of Correction (POC) was developed on 8/4/26 between Community Care Licensing (CCL) and the facility, with a due date of 8/5/26.During today's visit, LPA's conducted a health and safety check with bedridden residents, [See LIC 811 Confidential Name List for a description of select person identifiers used in this report], as identified during the visit conducted 8/4/26.

While touring the facility Staff 1 (S1) stated that they do not have keys to open the resident rooms. A deficiency will be given for the facility not providing a safe environment for the residents. A deficiency will be given for staff absent from their scheduled shift. A deficiency will be given regarding coverage by a designated substitute. A deficiency will be given for staff not following physician's medication order.

For today's visit deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. See LIC809-D dated for 8/8/26. A plan of correction was jointly developed with the Executive Director. An exit interview was conducted with Amber Rodgers, Executive Director to whom a copy of this report, the LIC 811, the POC, the LIC 421FC, and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.
Simon Jacob
Amy Domingo
DATE: 08/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2026
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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Document Has Been Signed on 08/08/2026 03:11 PM - It Cannot Be Edited


Created By: Amy Domingo On 08/08/2026 at 07:21 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: BONITA VILLA SENIOR LIVING
FACILITY NUMBER: 374604544

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2026
Section Cited
HSC
1569.695(f)(2)(A)

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A facility maintains a set of keys for residence rooms, staff are not able to promptly access an occupied resident room.This requirement has not been met as evidenced by:
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License agrees to provide direct care staff on all shifts key access to all occupied rooms by the end of the business day today.
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Based on observation and interview, the only caregiver (S1) responsible for 86 residents, did not have key access to 1 of 86 resident rooms. It took approximently seven minutes to obtain the correct key. This poses an immediate health risk to 1 of 98 residents in care.




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Type A
08/09/2026
Section Cited
CCR87413(a)(1)

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In each facility: when scheduled regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. This requirement has not been met as evidence by:
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License agrees to provide adequate staffing on all shifts for residents in care by POC date.
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Based on observation and interview, On 8/8/26, two of five scheduled caregivers were absent from their scheduled shift and coverage by qualified personnel was not in place for 3. This poses an immediate health risk to 98 of 98 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.
Simon Jacob
NAME OF LICENSING PROGRAM MANAGER:
Amy Domingo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/08/2026 03:11 PM - It Cannot Be Edited


Created By: Amy Domingo On 08/08/2026 at 09:33 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: BONITA VILLA SENIOR LIVING
FACILITY NUMBER: 374604544

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/09/2026
Section Cited
CCR
87405(a)

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87405 Administrator qualifications and duties (a) when the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in section...
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Management agrees to submit to the department list of designees responsible for managing the facility in their absence, clarifying who is responsible and when by POC date.
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This requirement has not been met as evidenced by:

Based on observation and interview, there was not coverage by a designated substitute for the administror who has the qualifications adequate to be responsible and accountable for nanagement of the facility. This poses an immediate health risk to 98 of 98 residents in care.




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Type A
08/09/2026
Section Cited
CCR87611(e)

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General requirements for allowable..in addition to 87465(a) and 87464(d) the license shall ensure that the resident is cared for in accordance with physician's orders, and the resident's medical needs are met.
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Management agrees to provide training for staff to recognize the resident's that need meals prior to medications by POC date.
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This requirement has not been met as evidenced by:

Based on observation and interview, Staff did not follow the physician's orders for resident's dia This poses an immediate health risk to 1 of 98 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.
Simon Jacob
NAME OF LICENSING PROGRAM MANAGER:
Amy Domingo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2026


LIC809 (FAS) - (06/04)
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