374604820-9-15-2025-08-AS-RCLK-DLV3FZ-20250925181333

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604820
Report Date: 09/15/2025
Date Signed: 09/15/2025 07:10:13 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2025 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20250911142556

FACILITY NAME:	NEW WORLD VILLA SOUTH		FACILITY NUMBER:	374604820
ADMINISTRATOR:	CHEN, ZAYDEN		FACILITY TYPE:	740
ADDRESS:	14125 TARZANA RD		TELEPHONE:	(858) 748-2888
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	6	CENSUS: 5	DATE:	09/15/2025
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Staff, April Magat		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Facility is unsanitary.
Facility is understaffed.

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 5

Control Number 08-AS-20250911142556

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: NEW WORLD VILLA SOUTH	FACILITY NUMBER: 374604820
	VISIT DATE: 09/15/2025

NARRATIVE

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It was also alleged that the facility is understaffed. During today's visit Staff 1 (S1) was the only staff present to provide all care and meals for five (5) residents, at the time of LPA's arrival. An interview with S1 revealed their main role was working as kitchen staff, however, was capable of providing care for the residents. S1 also disclosed their shift (today) began at 7:00 am. and ends at 6:00 pm., Staff 2 (S2) starts their shift at 8:00 am., who is trained to assist with insulin, however due to car issues did not arrive until 11:30 am., S1 revealed Resident 1 (R1) usually wakes up between 8:30 am. and 9:00 am., upon waking up R1 typically will have assistance to test their blood sugar level to determine if administration of insulin is needed, prior to breakfast. Today, due to S1 not being trained to assist R1 did not receive their testing/injection.

Based on Staff interviews, and record reviews, the complaint allegations were determined to be SUBSTANTIATED. A substantiated finding means the preponderance of evidence was met to prove the above listed allegations were met.

An exit interview was conducted with Staff Magat and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) will be provided at the conclusion of the visit.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 08-AS-20250911142556

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: NEW WORLD VILLA SOUTH	FACILITY NUMBER: 374604820
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/15/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/16/2025 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	Personnel Requirements - General. Facility personnel shall ... be sufficient in numbers, and competent to provide the services... to meet resident needs... The licensing agency may require any facility to provide additional staff whenever... the extent of services provided, or the physical arrangements of the facility require such additional staff for ... adequate services. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to have all staff scheduled to attend CCL approved training. Administrator will provide proof of completion by POC due date and completion of training by Friday, September 19, 2025. Administrator will send CCL proof by POC due date.
	8 9 10 11 12 13 14	Based on staff interviews and record reviews they did not have adequate staff to meet Resident 1 (R1) needs. This posed an immediate health risk to one out of five (5) residents in care.	8 9 10 11 12 13 14
Type B 11/12/2025 Section Cited CCR 87303(a)(1)	1 2 3 4 5 6 7	(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services...for... well-being of residents...(1) Floor surfaces ...and kitchen areas shall be maintained in a clean, sanitary...condition. This requirement was not as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to have pest control company service the facility, requiring all items to removed from kitchen cabinets and residents to be relocated for the duration of time specified by the company Administrator will send CCL proof of completion by POC due date.
	8 9 10 11 12 13 14	Based on LPA observations the facility kitchen had dead, as well as alive pests, in the kitchen cupboards. This posed a potential health and personal rights risk to five (5) residents 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.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2025 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20250911142556

FACILITY NAME:	NEW WORLD VILLA SOUTH		FACILITY NUMBER:	374604820
ADMINISTRATOR:	CHEN, ZAYDEN		FACILITY TYPE:	740
ADDRESS:	14125 TARZANA RD		TELEPHONE:	(858) 748-2888
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	6	CENSUS: 5	DATE:	09/15/2025
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Staff April Magat		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Licensee did not ensure Hospice resident's needs are met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to open a complaint investigation. LPA Correia was greeted by Caregiver April Magat, identified herself, and stated the purpose of the visit.

The Department’s investigation included staff interviews and resident record reviews.

On September 11, 2025, the Department received a complaint that alleged the Licensee did not ensure Hospice needs were met for Resident 1 (R1). Specifically, it was alleged the facility did not seek medical attention for R1's catheter that staff observed in need of maintenance/changing.

Based on Staff interviews, and record reviews, the complaint allegation was determined to be UNSUBSTANTIATED. An substantiated finding means the preponderance of evidence was not met to prove the above listed allegation were met.

An exit interview was conducted with Staff Magat and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) will be provided at the conclusion of the visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 08-AS-20250911142556

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: NEW WORLD VILLA SOUTH	FACILITY NUMBER: 374604820
	VISIT DATE: 09/15/2025

NARRATIVE

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Staff interviews and resident records reviews revealed staff notified R1's hospice agency of the issue and subsequently the hospice agency staff removed R1's catheter.

Based on interviews and record reviews the above listed allegation was determined Unsubstantiated. This finding means the preponderance of evidence standard was not met.

An exit interview was conducted with Staff Magat and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) will be provided at the conclusion of the visit.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 5