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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604751
Report Date: 03/26/2026
Date Signed: 03/26/2026 04:11:22 PM

Document Has Been Signed on 03/26/2026 04:11 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:NANCY VASQUEZ RESIDENTIAL CARE CENTERFACILITY NUMBER:
374604751
ADMINISTRATOR/
DIRECTOR:		CURTIS, PHILIP C.FACILITY TYPE:
735
ADDRESS:8627 TROY STREETTELEPHONE:
(619) 754-5250
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 42CENSUS: 41DATE:
03/26/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:22 PM
MET WITH:Nick Fierro,Administrator, TIME VISIT/
INSPECTION COMPLETED:
03:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced Case Management visit to deliver findings from a completed Case Management investigation. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Nick Fierro.

The Department previously conducted a separate Complaint investigation regarding neglect and lack of supervision and medication errors, concluding that case was Substantiated. With the current Case Management case, CCLD investigated the incidents of (1) failure to seek timely medical attention after C1's first suicide attempt, (2) staff falsifying medication logs due to medication errors and (3) staff not conducting a pre appraisal prior to Client 1 (C1) being placed at the facility. [See LIC 811 Confidential Names List for a description of select person and staff identifiers used.]

Records and interviews showed: On 12/08/2025, LPA Rogers received documents from the facility regarding C1. LPA observed there wasn't a resident appraisal completed by facility staff for review.

Records and interviews showed: Staff members admitted to not providing C1 with their medication for two weeks. Interviews revealed the medication records were falsely initialed verifying that the medications were given. Interviews revealed the staff members stated they initialed the records but did not provide the medications to the client.

[CONTINUED ON LIC 809-C]
NAME OF LICENSING PROGRAM MANAGER: Simon Jacob
NAME OF LICENSING PROGRAM ANALYST: Tiffany Holmes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2026
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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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: NANCY VASQUEZ RESIDENTIAL CARE CENTER
FACILITY NUMBER: 374604751
VISIT DATE: 03/26/2026
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[CONTINUED FROM LIC 809]

Records and interviews showed: S1 did not immediately call 911 to have C1 evaluated and did not notify other staff or the on-duty supervisor for assistance to get C1 medical or psychiatric aid after their first suicide attempt of climbing on the second story roof.

For each of the above cases, the Department interviewed pertinent facility staff and outside sources.

Based on the totality of evidence available to CCLD to date, the preponderance of evidence standard has been met and the allegations are valid.

Deficiencies were issued during today's Case Management visit.

An exit interview was conducted with Fierro, to whom a copy of this report, the LIC 811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
NAME OF LICENSING PROGRAM MANAGER: Simon Jacob
NAME OF LICENSING PROGRAM ANALYST: Tiffany Holmes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 03/26/2026 04:11 PM - It Cannot Be Edited


Created By: Tiffany Holmes On 03/26/2026 at 08:10 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: NANCY VASQUEZ RESIDENTIAL CARE CENTER
FACILITY NUMBER: 374604751

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/24/2026
Section Cited
CCR
80065(a)

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80065 Personnel Requirements
(a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement was not met, as evidenced by:
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The Licensee will immediately study with staff CCR regulations 80065(a) regarding pre-placement appraisals. The Licensee will provide training to all staff by an outside source on proper Pre-Appraisals and how and when to complete the preplacement forms by 04/24/2026
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Based on records review and interviews, the Licensee failed to seek timely medical attention for 1 out of 41 clients (C1) after C1's first suicide attempt resulting in unmet care needs and contributing to a serious injury later diagnosed at the hospital. This poses an immediate health, safety,and personal rights risk to residents in care.
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Type B
04/24/2026
Section Cited
CCR80012(a)

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80012 False Claims
(a) No licensee, officer, or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement was not met, as evidenced by:
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Licensee will have staff review 80012 (a)FALSE CLAIMS and provide training to staff on the regulation. Licnesee will provide signed doumentation that staff reviewed 80012 and provide trainging materials and a sign in sheet for training to CCL by POC due date of 04/24/2026.
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Based on interviews and record reviews, Two facility staff falsified documents regarding medication for 1 out of 41 clients (C1). This posed a potential personal rights risk to all residents in 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:
Tiffany Holmes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/26/2026 04:11 PM - It Cannot Be Edited


Created By: Tiffany Holmes On 03/26/2026 at 08:44 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: NANCY VASQUEZ RESIDENTIAL CARE CENTER
FACILITY NUMBER: 374604751

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/24/2026
Section Cited
CCR
80068.2(a)

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80068.2 Needs and Services Plan (a) The licensee shall complete a Needs and Services Plan for each client as required in Sections 81068.2, 82068.2, 82568.2, 84068.2, or 85068.2.
This requirement was not met, as evidenced by:
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Licensee will provide training to staff on needs and service plans/reevaluation by an outside source. Licensee will provide training materials and a sign in sheet for traininng to CCL by POC due date of 04/24/2026.
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Based on interviews and record reviews, facility staff did not provide a needs and service plan for 1 out of 41 clients (C1). This posed a potential personal rights risk to all residents in 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:
Tiffany Holmes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2026


LIC809 (FAS) - (06/04)
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