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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601936
Report Date: 06/17/2025
Date Signed: 06/17/2025 01:38:17 PM

Document Has Been Signed on 06/17/2025 01:38 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:VMB ULTIMATE CAREFACILITY NUMBER:
374601936
ADMINISTRATOR/
DIRECTOR:		VIRGIL P. BUCATCATFACILITY TYPE:
740
ADDRESS:344 E 27TH STTELEPHONE:
(619) 434-4565
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 6CENSUS: 6DATE:
06/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Caregiver Ben RosarioTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Ben Rosario. Manager Milagros Bucatcat arrived during the visit.

During today's visit, LPA toured the facility, reviewed facility records, observed residents in care, and spoke with staff. Review of resident records revealed that one resident did not have an initial medical assessment and multiple residents had medical assessments which were incomplete. During the tour of the facility, LPA observed multiple medications stored in the unsecured refrigerator in the kitchen as well as all resident medications stored in an unlocked cabinet in the facility kitchen. LPA spoke with Caregiver Rosario and Manager Bucatcat who stated that the kitchen is normally locked, however, LPA observed the facility kitchen door to remain open and unlocked for a majority of the visit. During the tour of the facility, LPA observed two individuals who Manager Bucatcat stated were not residents or staff. Manager Bucatcat stated that Tenant 1 (T1) was renting a room and Tenant 2 (T2) was their partner. LPA spoke with T1 and learned that T1 has been renting a room for 4.5 years and T2 has been at the facility approximately once a week for 4 months. LPA verified on Guardian that neither individual had active fingerprint clearance or association to the facility. [Manager was provided with an LIC811 Confidential Names List to identify residents, T1, and T2].



Continued on LIC809-C page...
NAME OF LICENSING PROGRAM MANAGER: Jennifer Lott
NAME OF LICENSING PROGRAM ANALYST: Rebecca A Borunda
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2025
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 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: VMB ULTIMATE CARE
FACILITY NUMBER: 374601936
VISIT DATE: 06/17/2025
NARRATIVE
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Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed. LPA provided Manager Bucatcat with a copy of the facility's current Guardian roster, and written documentation regarding the facility's annual licensing fee balance and Administrator Certificate status of Licensee Virgil Bucacat.

The following deficiencies were cited for incomplete medical assessments, unsecured medications, and non-cleared individuals and noted on the attached LIC809-D pages. Additionally, a civil penalty in the amount of $1,000 was assessed for T1 and T2 not being finger print cleared and noted on the attached LIC421BG form.

An exit interview was conducted with Manager Milagros Bucatcat, whose signature below confirms receipt of a copy of this report, the LIC811, the LIC421BG, and the Licensee Appeal Rights (LIC9058 3/22).
NAME OF LICENSING PROGRAM MANAGER: Jennifer Lott
NAME OF LICENSING PROGRAM ANALYST: Rebecca A Borunda
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 06/17/2025 01:38 PM - It Cannot Be Edited


Created By: Rebecca A Borunda On 06/17/2025 at 11:43 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: VMB ULTIMATE CARE
FACILITY NUMBER: 374601936

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)(2)
87355 Criminal Record Clearance (e) All individuals subject to a criminal record review… shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department…

This requirement has not been met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in that T1 and T2 were residing and/or present at the facility without a valid fingerprint clearance. This poses an immediate safety risk to 6 of 6 residents in care.
POC Due Date: 06/18/2025
Plan of Correction
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LPA observed T1 and T2 leave the facility during the visit. Manager will be giving T1 a written 30-day eviction notice and will come up with an agreement with T1 to ensure that T1 does not return to the facility without being fingerprint cleared and associated during the 30-day notice period. Manager stated that she will send a copy of the eviction notice to the Department by POC due date of 6/18/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Jennifer Lott
NAME OF LICENSING PROGRAM MANAGER:
Rebecca A Borunda
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/17/2025 01:38 PM - It Cannot Be Edited


Created By: Rebecca A Borunda On 06/17/2025 at 12:02 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: VMB ULTIMATE CARE
FACILITY NUMBER: 374601936

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(h)(2)
87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement has not been met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that resident medications are stored in an unsecured cabinet and refrigerator located in the facility kitchen. This poses a potential safety risk to 6 of 6 residents in care.
POC Due Date: 07/17/2025
Plan of Correction
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Manager stated that she will lock the medication cabinet and will obtain a locked container to safely store medication in the fridge. Manager will reach out to the pharmacy to train all staff on proper medication storage and provide proof of training to the Department by POC due date of 7/17/2025.
Type B
Section Cited
CCR
87458(a)
87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record.

This requirement has not been met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that the medical assessments for R1, R2, and R3 were incomplete. This poses a potential health risk to 6 of 6 residents in care.
POC Due Date: 07/17/2025
Plan of Correction
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Manager will reach out to residents' families for them to obtain completed medical assessments. Manager will provide LPA with written notice that the medical assessments for R1, R2 and R3 are complete and stored in the residents' files by POC due date of 7/17/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Jennifer Lott
NAME OF LICENSING PROGRAM MANAGER:
Rebecca A Borunda
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2025


LIC809 (FAS) - (06/04)
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