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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601936
Report Date: 09/18/2025
Date Signed: 09/18/2025 03:11:40 PM

Document Has Been Signed on 09/18/2025 03:11 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: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: 5DATE:
09/18/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:House Manager Milagros BucatcatTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to cite deficiencies. LPA identified herself to, was greeted by, and explained the purpose of the visit to House Manager Milagros Bucatcat.

Review of the Department’s Active Administrator List dated 9/16/2025 revealed that Virgil P. Bucatcat, who is the currently listed Administrator for the facility, did not have an active or pending renewal for an Administrator Certificate, and their latest Administrator Certificate expired in 2013. Additionally, Staff 1, [House Manager was provided with an LIC811 Confidential Names List to identify individuals] who was acting as a facility manager did not have active or pending renewal for Administrator Certificate. Review of an Administrator Certificate for Staff 2 revealed that S2 had an active Administrator Certificate for residential care facilities for the elderly, however, interviews confirmed that facility management had not submitted a Change of Administrator request to the Department.

Additionally, Staff 1 stated during multiple conversations that only Residents 1 and 2 were receiving hospice services and Residents 3, 4, 5, 6, and 7 were not receiving hospice services. Staff 1 only provided LPA Borunda with hospice records for R1 and R2. However, interviews with outside sources and review of facility records revealed that Residents 1-7 were under the care of a hospice provider and were receiving hospice services. Residents 1-6 were all admitted to the facility at the same time, which placed the facility over their approved and pending hospice waiver requests. In 2013, the facility was originally approved to admit 2 hospice residents, however in 2022, the facility applied for a hospice waiver increase from 2 to 4 residents.
Continued on LIC809-C page...
NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Rebecca A Borunda
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2025
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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Document Has Been Signed on 09/18/2025 03:11 PM - It Cannot Be Edited


Created By: Rebecca A Borunda On 09/18/2025 at 01:40 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: 09/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/25/2025
Section Cited
CCR
87207

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87207 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 has not been met as evidenced by: Based on interviews and records review,
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House Manager will submit a written letter to the Department stating that S1 will be truthful when interacting with representatives from the Department and the LIC9098 Self Certification of Deficiencies Cleared to the Department by POC due date of 9/25/2025.
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the Licensee did not comply with the section cited above in that S1 stated that only 2 of 6 residents were receiving hospice services, when it was actually 6 of 6 residents. This poses a potential person rights risk to 5 of 5 residents in care.
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LPA provided House Manager with LIC9098 Self Certification of Deficiencies Cleared.
Type B
09/25/2025
Section Cited
CCR87407(k)(1)

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87407 (k) Whenever a certified administrator assumes… responsibility for administering a residential care facility for the elderly, he or she shall provide written notice, within thirty (30) days, to: (1) The local licensing office… This requirement has not been met as evidenced by:
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House Manager will submit the LIC308, copy of S2's Administrator Certificate, and a written request to change the Administrator to S2 to the Department by POC due date of 9/25/2025.
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Based on interview and record review, the Licensee did not comply with the section cited above in that a written notice of S2 acting at the facility’s administrator was not submitted to the Department. This poses a potential safety risk to 5 of 5 residents in care.
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LPA provided House Manager with LIC308 and Change of Administrator Checklist.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:
Rebecca A Borunda
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/18/2025 03:11 PM - It Cannot Be Edited


Created By: Rebecca A Borunda On 09/18/2025 at 02:13 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: 09/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2025
Section Cited
CCR
87632(a)

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87632 (a) In order accept or retain terminally ill residents… the licensee shall have obtained a facility hospice care waiver from the Department… This requirement has not been met as evidenced by:
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House Manager submitted a hospice waiver request for 6 residents after 7/23/2025, which the Department has received and is currently reviewing.
DEFICIENCY CLEARED
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Based on interview and record review, the Licensee did not comply with the section cited above in that the facility was caring for 6 hospice residents without requesting an hospice waiver for 6 residents. This posed a potential health risk to 6 of 6 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.
Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:
Rebecca A Borunda
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2025


LIC809 (FAS) - (06/04)
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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: 09/18/2025
NARRATIVE
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Following a visit from the Department on 7/23/2025, S1 submitted a hospice waiver increase to 6 residents, which is still pending with the Department. Therefore the following deficiencies for lack of active Administrator, false claims, and over capacity for hospice residents are being cited per California Code of Regulations Title 22 and noted on the attached LIC809-D pages.

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

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC809 (FAS) - (06/04)
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