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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604542
Report Date: 12/23/2025
Date Signed: 12/23/2025 01:01:18 PM

Document Has Been Signed on 12/23/2025 01:01 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:RANCHO PENASQUITOS SENIOR LIVINGFACILITY NUMBER:
374604542
ADMINISTRATOR/
DIRECTOR:		HEBNER, WESFACILITY TYPE:
740
ADDRESS:12979 RANCHO PENASQUITOS BLVDTELEPHONE:
(858) 215-5820
CITY:SAN DIEGOSTATE: CAZIP CODE:
92129
CAPACITY: 120CENSUS: 76DATE:
12/23/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Memory Care Director Cristina Coronado and Executive Director Heather Myers TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced Case Management visit to follow up on an incident reported to Community Care Licensing. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Memory Care Director Cristina Coronado. Executive Director (ED) Heather Myers arrived later during the visit.

Community Care Licensing received an Incident Report on 12/22/25 in which it was reported that on 12/8/25, a Resident (identified as R1), was noticed not to be present by a caregiver around 11:30am. Per the report, multiple staff then searched the facility to find R1, who was found to have fallen down a stairwell with their wheelchair on top of them. R1 was noted to be awake and alert and staff contacted emergency services who then transported R1 to the hospital where they were treated for a large hematoma to their glute area. R1 returned to the facility 12/11/25 with orders for new medications.

During today's visit, LPA conducted interviews and file review. Additionally, LPA conducted a health and safety visit with R1. Per staff interviews, a fire alarm had gone off during lunch (from 11am-12pm) and staff began conducting room checks after it had been determined to be a false alarm from the kitchen. Staff interviews corroborated that R1 must've panicked or gotten confused from the alarm and tried to self-evacuate from their room before staff got to them. The stairwell R1 fell in is immediately next to R1's room. Interview with the staff member who first noted R1 to be missing from their room stated that they had assisted R1 with bathing earlier and that R1 was seated in their recliner watching television when the staff member left to assist the next resident with their shower.

[Continued on LIC 809-C]
NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Arian Golbakhsh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2025
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: RANCHO PENASQUITOS SENIOR LIVING
FACILITY NUMBER: 374604542
VISIT DATE: 12/23/2025
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[Continued from LIC 809]

All staff interviews corroborated that R1 is a fall risk and required assistance when ambulating with their walker or wheelchair. File review of R1's physician's report (dated September 2023) revealed that R1 has a diagnosis of Dementia and utilizes a walker due to motor impairment. Per review of R1's assessment dated June 2025, R1 is noted to ambulate independently with or without an assistive device and noted to be a fall concern.

However, per R1's service plan dated December 2023, R1 requires total assist with ambulation. It is noted that R1 is able to ambulate with the assistance of a walker but that an escort will be provided for safety.
R1's full service plan was not updated until December 2025, after this incident. Per review of the new service plan, R1 remains a total assist for ambulation and that R1 will be escorted to meals and activities. Goals and interventions to reduce R1's fall risk now include additional reminders to utilize their pendant for assistance and for staff to provide reminders for R1 to utilize their assistive device if observed trying to ambulate without it. Per interview with administrative staff, the facility has also implemented higher frequency checks on R1 (hourly).

The facility responded accordingly by conducting room checks after a fire safety event and conducting a search once R1 was noted to be unaccounted for and then arranging for prompt medical attention once found. However, one (1) Type B deficiency is being cited today as the facility failed to submit a written report of the incident to the Department within seven (7) days. Date of incident was 12/8/25, date of report submission was 12/21/25. Details of the deficiency are noted on the attached LIC 809-D along with Plan of Correction (POC).

One deficiency was cited during today's visit. An exit interview was conducted with Executive Director Myers to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.
NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Arian Golbakhsh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/23/2025 01:01 PM - It Cannot Be Edited


Created By: Arian Golbakhsh On 12/23/2025 at 12:15 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: RANCHO PENASQUITOS SENIOR LIVING
FACILITY NUMBER: 374604542

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2026
Section Cited
CCR
87211(a)(1)

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87211(a)(1): A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below.

This requirment is not met as evidenced by:
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Licensee will conduct an in-service review with staff on reporting requirements as outlined in CCR 87211 and submit proof to LPA by POC due date.
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Based on file review and interviews, the Licensee did not ensure submission of incident reports to the Department were within the required timeframe, posing a potential health, safety, and personal rights risk to 76 out of 76 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:
Arian Golbakhsh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/23/2025


LIC809 (FAS) - (06/04)
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