374602117-3-25-2026-08-AS-CLOZ-DS92SC-20260316173855

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374602117
Report Date: 03/16/2026
Date Signed: 03/25/2026 05:10:50 PM

Document Has Been Signed on 03/25/2026 05:10 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:	TOMAS RESIDENTIAL CARE		FACILITY NUMBER:	374602117
ADMINISTRATOR/ DIRECTOR:	NORMA TOMAS		FACILITY TYPE:	740
ADDRESS:	6344 JOUGLARD ST		TELEPHONE:	(619) 773-6091
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92114
CAPACITY: 6		CENSUS: 3	DATE:	03/16/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:35 AM
MET WITH:	Norma Tomas, Licensee		TIME VISIT/ INSPECTION COMPLETED:	05:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself and was granted entry by Licensee Abraham Tomas. LPA discussed the purpose of the visit with Administrator Norma Tomas, who was present at the facility. According to the facility’s license, there may be a maximum of six (6) residents, all of whom may be non-ambulatory in at any given time at the facility site. It was noted that the facility did have a dementia plan on file. During today’s inspection, the facility’s current census is three (3) residents living at the facility. There were 3 residents present at the facility site during the inspection. LPA, accompanied by Administrator Tomas, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present and safely stored in the garage. The facility had sufficient space to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 73º degrees Fahrenheit (F). Hot water temperature at taps accessible to clients were also compliant. At least 2 days of perishable food and at least 7 days of non-perishable food were present in their second kitchen area. Cooking, dining equipment, and utensils were present and safely stored. No toxic chemicals or poisons were inaccessible to residents. [Continuation on LIC809-C]

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026

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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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: TOMAS RESIDENTIAL CARE	FACILITY NUMBER: 374602117
	VISIT DATE: 03/16/2026

NARRATIVE

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Medications were properly labeled, as required, and stored in a locked cabinet, which LPA inspected and observed that the medications were not in their original containers.

There are no pools or bodies of water on the facility premises. Per Administrator Norma Tomas, there are no weapons or ammunition kept on the facility grounds. Fire extinguishers were present (01) and serviced within the last 12 months. First aid kits were complete and readily accessible. The fireplace was not in use and was inaccessible to residents.

LPA spoke with staff and briefly with residents, and reviewed staff and resident records. The facility did not maintain a current administrator certificate. LPA’s visit did not raise any licensing concerns. The files that LPA reviewed contained required documents that will need to be updated by the end of the month. Confidential records were stored in a locked cabinet. Required licensing postings were observed in a visible area of the facility.

There were deficiencies observed and cited during today's annual inspection, and may be reviewed on the LIC809-D page of this report.

An exit interview was conducted with Licensee Norma Tomas, to whom a copy of this report, along with the Licensee/Appeal Rights (LIC9058 03/22), were provided at the conclusion of the visit. The signature below confirms that the documents were received.

LPA requested licensee Norma Tomas to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, and Emergency Disaster Plan LIC 610-E, to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov .

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/25/2026 05:10 PM - It Cannot Be Edited

Created By: Carmen Lopez On 03/16/2026 at 04:55 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: TOMAS RESIDENTIAL CARE	FACILITY NUMBER: 374602117
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/16/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87412(a)(13)(B)1

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). 1. For Certified Administrators, a copy their current and valid Administrative Certification meets this requirement. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 1 staff did not obtain their updated Administrator's certificate which posed a potential personal rights risk to persons in care.
	POC Due Date: 03/31/2026
	Plan of Correction
1 2 3 4	Licensee agreed to reach out to TSP and request assistance to get recertification for their Administrator and submit their email to LPA by POC due date 03/31/2026.

Type B

Section Cited

CCR

87465(h)(5)

Incidental Medical and Dental Care Services

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 3 out of 3 resident's medications were stored in medication boxes which posed a potential health risk to persons in care.
	POC Due Date: 03/31/2026
	Plan of Correction
1 2 3 4	Licensee agreed to remove the medication from the containers and toss the containers away and ensure the medications are maintained in their original containers by POC due date, 03/31/2026.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Robyn Clark
NAME OF LICENSING PROGRAM MANAGER:

	Carmen Lopez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/25/2026 05:10 PM - It Cannot Be Edited

Created By: Carmen Lopez On 03/16/2026 at 04:55 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: TOMAS RESIDENTIAL CARE	FACILITY NUMBER: 374602117
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/16/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1569.695(c)

Other Provisions

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above in the fire drills not being completed which posed a potential safety risk to persons in care.
	POC Due Date: 03/31/2026
	Plan of Correction
1 2 3 4	The facility will conduct their fire drill and send to LPA by POC due date, 03/31/2026.

Type B

Section Cited

HSC

1569.695(e)(3)

Other Provisions

(e) A facility shall have all of the following information readily available to facility staff during an emergency: (3) A resident medication list for residents with centrally stored medications. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in 3 out of 3 residents did not have updated medication profile sheets or medication list which posed a potential health risk to persons in care.
	POC Due Date: 03/31/2026
	Plan of Correction
1 2 3 4	The facility will contact the pharmacy and case worker for an updated medication list and will email LPA once they have obtained residents medication list by POC due date 03/31/2026.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Robyn Clark
NAME OF LICENSING PROGRAM MANAGER:

	Carmen Lopez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026

LIC809 (FAS) - (06/04)

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