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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603285
Report Date: 05/07/2026
Date Signed: 05/07/2026 11:05:20 AM

Document Has Been Signed on 05/07/2026 11:05 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:QUEEN'S MANOR HOME CAREFACILITY NUMBER:
374603285
ADMINISTRATOR/
DIRECTOR:		JANE TOTANESFACILITY TYPE:
740
ADDRESS:1025 BONNIE BRAE PLACETELEPHONE:
(760) 806-9455
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 6CENSUS: 4DATE:
05/07/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:58 AM
MET WITH:ADMINISTRATOR, ROGER TOTANESTIME VISIT/
INSPECTION COMPLETED:
11:08 AM
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On May 07, 2026, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Annual Inspection and met with the Administrator, Roger Totanes. The facility file review was conducted in the Regional Office and additional forms were reviewed and requested on site. The facility is operating at a capacity of four Adults but is licensed for six.

LPA Mixson toured the facility along with the Administrator, Roger Totanes, and made observations pertaining to the annual visit. The toured included the inside and outside of the facility. There were no obstructions or clutter to the indoor or outdoor passageways currently. The facility is a single-story home located at 1025 Bonnie Brae Place, Vista, CA 92084.

Physical Plant: The facility phone number is (760) 806-9455 and it is operable. The LPA observed the four residents’ bedrooms. Each was equipped with required furniture as per Title 22. LPA Mixson inspected the four facility bathrooms. The hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately. The smoke detectors, carbon monoxide alarms, and fire extinguishers were observed to be operable currently.

LPA Mixson observed the required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman made a visit this year 2026, and posters are posted.

The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the residents and staff files, and it was locked and inaccessible to residents in care at the time of this visit. Swimming pool was gated with a lock, and inaccessible to residents at the time of this visit and there is no water currently.

NAME OF LICENSING PROGRAM MANAGER: Jazmond D Harris
NAME OF LICENSING PROGRAM ANALYST: Venus Mixson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2026
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: QUEEN'S MANOR HOME CARE
FACILITY NUMBER: 374603285
VISIT DATE: 05/07/2026
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Medications: The medication were observed to be locked and inaccessible to residents in care. Located in a cabinet next to the fireplace, with glass see through cabinet doors. There was a sufficient supply of medication for the four residents in care at the time of this visit. The overall facility is clean; the furniture is in good condition. The facility cooling system and other appliances were operable at the time of this visit, and there were safety lights for night.

Food Service: LPA observed the food supply was sufficient per regulations, and there are a variety of food types available. Menu was posted and Administrator indicated that the menu is followed with no special diets. Administrator advised that the facility staff shop twice a week and as needed. The utensils and kitchenware were in sufficient supply and stored orderly. LPA observed the sharp items to be locked and inaccessible to the residents.

Care & Supervision: Currently there are two staff members providing care and supervision to the residents. Administrators certificate is current at the time of this visit with an expiration date of 11/20/2026.

Records Review: The LPA reviewed resident and staff files all files had requested documents. Resident files included; Admission agreements, current TB test and other documents as requested. Previous Community Care Licensing forms were reviewed by LPA.

There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit.

An exit interview was conducted, and a copy of this report was explained given to the Administrator, Roger Totanes.

NAME OF LICENSING PROGRAM MANAGER: Jazmond D Harris
NAME OF LICENSING PROGRAM ANALYST: Venus Mixson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
LIC809 (FAS) - (06/04)
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