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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601468
Report Date: 09/10/2025
Date Signed: 09/10/2025 07:07:39 PM

Document Has Been Signed on 09/10/2025 07:07 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:EMMAUS CARE IFACILITY NUMBER:
374601468
ADMINISTRATOR/
DIRECTOR:		DEENA SHAHFACILITY TYPE:
740
ADDRESS:8738 COVINA STREETTELEPHONE:
(858) 566-4625
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: 6CENSUS: 6DATE:
09/10/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
06:01 PM
MET WITH:Licensee, Janette MonillasTIME VISIT/
INSPECTION COMPLETED:
07:15 PM
NARRATIVE
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Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management- Deficiencies visit. LPA was greeted and allowed entry into the facility by staff, Elena Catacutan. LPA met with Licensee, Janette Monillas.

During a complaint investigation, it was discovered that the licensee hired a management company, Bright Senior Management (BSM), LLC on 09/01/24. The management company was present at times in the facility and responsible for new admissions. Two (2) of the employees at BSM, LLC did not have the required Criminal Record Clearance. Staff #1 (S1) has a Criminal Record Exemption on file but was never associated with this facility or received approval for the transfer of a criminal record exemption to this facility. Staff #2 does not have a fingerprint clearance or association with this facility.

It was also discovered the licensee signed off approval on an Incident Report and Death Report for Resident #1 (R1) with inaccurate information. The incident Report dated 03/07/25 indicated R1 became restless due to claustrophobia and was provided with prescribed medication. The report also stated R1 was restless due to their roommate experiencing a medical emergency. The death report listed a medical condition as the cause of death, instead of true events. R1 had diabetes that required insulin injections. The facility was aware R1 required insulin injections, prior to admission. The facility’s staff are not skilled professionals, only the licensee is a medical professional. The facility’s documentation did not list the high blood sugar, which later resulted in death. The licensee approved false claims made on the reports.

Deficiencies were cited on the attached LIC 809D and Civil Penalties were assessed on the LIC 421's. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee, Janette Monillas whose signature below confirms receipt of these rights.
NAME OF LICENSING PROGRAM MANAGER: Lizzette Tellez
NAME OF LICENSING PROGRAM ANALYST: Natasha Persaud
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2025
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 09/10/2025 07:07 PM - It Cannot Be Edited


Created By: Natasha Persaud On 09/10/2025 at 01:04 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: EMMAUS CARE I
FACILITY NUMBER: 374601468

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/11/2025
Section Cited
CCR
87355(e)(4)

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Criminal Record Clearance. All individuals subject to a criminal record review...prior to working, residing... Request and be approved for a transfer of a criminal record exemption...the Department permits the individual to be employed, reside or be present at the facility.
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The licensee stated she now has access to Guardian and will ensure individuals are fingerprint cleared, associated, and any exemptions are transferred prior to allowing the staff to work or be present in the facility. The licensee stated she will attend vendor training on Criminal Record Clearance.
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This requirement is not met as evidenced by:
Based on interviews and record review, the licensee allowed 1 out of 8 [S1] staff to work prior to receiving an approved exemption, which posed an immediate health and safety risk to residents in care.
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The licensee will schedule the training by the POC due date and provide scheduled information. The licensee will submit proof of training within 2 weeks. A civil penalty was assessed.
Type A
09/11/2025
Section Cited
CCR87355(e)(2)

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Criminal Record Clearance. Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by:
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The licensee stated she now has access to Guardian and will ensure individuals are fingerprinted cleared and associated prior to allowing the facility to work or be present in the facility. The licensee stated she will attend vendor training on Criminal Record Clearance.
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Based on interviews and record review, the licensee allowed 1 out of 8 [S2] staff to work prior to receiving an approved criminal record clearance, which posed an immediate health and safety risk to residents in care.
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The licensee will schedule the training by the POC due date and provide scheduled information. The licensee will submit proof of training within 2 weeks. A civil penalty was assessed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lizzette Tellez
NAME OF LICENSING PROGRAM MANAGER:
Natasha Persaud
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2025


LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 09/10/2025 07:07 PM - It Cannot Be Edited


Created By: Natasha Persaud On 09/10/2025 at 01:10 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: EMMAUS CARE I
FACILITY NUMBER: 374601468

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/22/2025
Section Cited
CCR
87207

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False Claims. 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 is not met as evidenced by:
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The Licensee stated the information they provided were the facts provided to them by the management company. The licensee has ceased the agreement with the management company. The licensee stated she will attend training on Reporting Requirements and provide proof by POC due date.
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Based on interviews and record review, the licensee did not ensure reports were accurrate for 1 out of 4 [R1] residents, which posed a potential health and safety risk to 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.
Lizzette Tellez
NAME OF LICENSING PROGRAM MANAGER:
Natasha Persaud
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2025


LIC809 (FAS) - (06/04)
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