374602117-4-29-2026-08-AS-CLOZ-DTLW3U-20260429165632

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374602117
Report Date: 04/29/2026
Date Signed: 04/29/2026 04:58:33 PM

Document Has Been Signed on 04/29/2026 04:58 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:	04/29/2026
TYPE OF VISIT:	POC	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:42 PM
MET WITH:	Norma Tomas, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:10 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 case management visit for a Plan of Correction clearance. LPA Lopez identified herself and was allowed entry by Administrator Norma Tomas. LPA met with Administrator Tomas and discussed the purpose of the visit. On 03/16/26, the facility was issued four (4) deficiencies [Plan of Corrections (POC)] for not having an updated Administrator’s Certificate, medications not being in their original containers, a quarterly fire drill, and a medication list for residents with centrally stored medications. During today’s visit, LPA was provided with information regarding their Administrator’s Certificate, which was in progress. The facility had agreed they would contact the Technical Support Program (TSP) for assistance with recertification, which was completed. This POC is deemed cleared during this visit. The facility agreed to follow up with LPA once they have obtained their certificate. The facility was issued a citation for obtaining medications in pill boxes, and according to their POC, they decided to remove the pill boxes and maintain their medications in their original containers. During the visit with TSP, they assisted with ensuring that the facility was within the scope of Title 22 regulations, and they were advised only to pour daily medications. LPA observed that the facility was in compliance and observed that only the medications for that day were poured. Based on the Department's instructions and LPA's observations, the facility is within the scope of the regulations. This citation is deemed cleared during today’s visit. (Continuation on LIC809-C)

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026

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 3

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)

Page: 2 of 3

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: 04/29/2026

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
26
27
28
29
30
31
32

(Continuation of LIC809)

The facility was issued a citation for not conducting their quarterly fire drill. According to their POC, they were to conduct a fire drill. During today’s visit, LPA observed that the facility had completed their quarterly fire drill in March 2026. They are aware that their next fire drill will be conducted in June 2026. Based on LPA's review of the record, this citation is deemed cleared during today’s inspection.

The facility was issued a citation for not having updated medication lists for resident #1 (R1 – see confidential names list), resident #2 (R2 – see confidential names list), and resident #3 (R3 – see confidential names list). An updated medication list was provided for R1, but the facility was unable to provide an updated medication list for R2 or R3. This POC is not deemed cleared during today’s visit, and a failure to correct will be issued.

No additional deficiencies were observed, but a civil penalty (CP - LIC421FC) for failure to correct was issued during today’s visit. An exit interview was conducted, CP was issued, and a copy of this report, along with Licensee Rights (LIC 9058 03/22), were provided to Administrator Norma Tomas at the conclusion of the visit. The signature below confirms receipt of these documents.

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026

LIC809 (FAS) - (06/04)

Page: 3 of 3