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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604595
Report Date: 07/26/2025
Date Signed: 07/26/2025 04:00:53 PM

Document Has Been Signed on 07/26/2025 04:00 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:HILLTOP HOME CARE CENTERFACILITY NUMBER:
374604595
ADMINISTRATOR/
DIRECTOR:		ANTONIO, JANE ARLYN H.FACILITY TYPE:
735
ADDRESS:110 ORANGE DRIVETELEPHONE:
(619) 777-3746
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 4CENSUS: 3DATE:
07/26/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Co-Administrator Yuri VegaTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to cite a deficiency identified during a separate complaint investigation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Co-Administrator Yuri Vega. LPA also spoke briefly with Licensee Gil Antonio via phone during the visit.

Licensee’s care records on Client #1 (C1) well-established that C1 had a long history/pattern of substance abuse, which threatens C1’s welfare and wellbeing and undermines the goals outlined in their San Diego Regional Center (SDRC) Individual Program Plan (IPP). [See LIC811 Confidential Names List for a description of C1.] Marijuana was not part of C1's list of physican-approved medications.

Facility Manager Staff #2 (S2) reported knowing that C1 had a positive drug test on 06/23/2025. On 06/25/2025, S2 told CCLD that a few days prior, facility Staff #4 (S4) found a drug pipe/tube in C1’s bedroom. S2 admonished C1 (since drug use at the facility is prohibited by house rules and may lead to C1’s eviction.) On 07/14/2025, S2 told CCLD that two days prior, they smelled marijuana in C1’s bedroom. S2 again admonished C1, who admitted recently smoking marijuana.

On 06/27/2025, S4 confirmed to CCLD that a few days earlier they were cleaning C1’s bedroom and saw a pipe with a marijuana leaf inside it, in plain view, which they reported to S2. S4 said there have been other occasions when they smelled marijuana in C1’s bedroom.

[CONTINUED ON LIC 809-C]
NAME OF LICENSING PROGRAM MANAGER: Simon Jacob
NAME OF LICENSING PROGRAM ANALYST: Dang Nguyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2025
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 4
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: HILLTOP HOME CARE CENTER
FACILITY NUMBER: 374604595
VISIT DATE: 07/26/2025
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[CONTINUED FROM LIC 809]

Staff #3 (S3) said they once smelled marijuana in C1’s bedroom, and C1 admitted to S3 that they had recently smoked such.

Since C1 moved into the facility in October 2024, CCLD has not received any written incident reports from Licensee regarding instances of C1’s drug use or drug paraphernalia being found in C1’s bedroom. The case-carrying LPA has also not received verbal notifications of such from Licensee. Regarding reporting requirements, one (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). A Plan of Correction was jointly developed with the Licensee.

An exit interview was conducted with Co-Administrator Yuri Vega, to whom a copy of this report, the LIC 809-D, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
NAME OF LICENSING PROGRAM MANAGER: Simon Jacob
NAME OF LICENSING PROGRAM ANALYST: Dang Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/26/2025 04:00 PM - It Cannot Be Edited


Created By: Dang Nguyen On 07/26/2025 at 03:35 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: HILLTOP HOME CARE CENTER
FACILITY NUMBER: 374604595

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2025
Section Cited
CCR
80061(a)(1)(D)

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80061 Reporting Requirements: “(a) Upon the occurrence, during the operation of the facility, of any of the events specified…a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report…shall be submitted to the licensing agency within seven days… (1) Events reported shall include…: (D) Any unusual incident…which threatens the physical or emotional health or safety of any client.” This requirement was not met, as evidenced by:
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Licensee agreed to prepare a Special Incident Report (SIR) for C1, detailing the drug-related events described in this report, as well as any others which Licensee’s staff are aware of, and to E-mail the SIR to C1’s SDRC Service Coordinator and CCLASCPSanDiegoRO@dss.ca.gov (while Cc’ing LPA Nguyen), by the POC due date.
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Based on records and interviews, Licensee did not report unusual incidents which threatened the emotional health or safety of 1 of 4 clients (C1) to CCLD by the agency’s next working day and submit a written report within seven days of incident occurrence. This posed a potential health and safety risk to persons 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:
Dang Nguyen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2025


LIC809 (FAS) - (06/04)
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