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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 08/08/2025
Date Signed: 08/08/2025 10:53:52 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/03/2025 and conducted by Evaluator Carmen Lopez
COMPLAINT CONTROL NUMBER: 08-AS-20250403173506
FACILITY NAME:BONITA VILLA SENIOR LIVINGFACILITY NUMBER:
374604544
ADMINISTRATOR:REBECCA TOVESFACILITY TYPE:
740
ADDRESS:3434 BONITA ROADTELEPHONE:
(619) 476-9444
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:145CENSUS: 127DATE:
08/08/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Annmarie Salazar, Resident Service CoordinatorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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- Lack of supervision resulting in resident-on-resident altercation
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver findings for a complaint investigation. LPA identified herself and was granted entry by Annmarie Salazar, Resident Service Coordinator (RSC). LPA stated the purpose of the visit and reviewed the findings of the complaint with RSC Salazar.

The Department’s investigation consisted of interviews with staff and residents, and records review of relevant documents pertinent to this investigation. On April 03, 2025, it was reported there was a lack of supervision which resulted in resident-on-resident altercation.

It was specifically alleged on April 1, 2025, resident #1 (R1) had an altercation with resident #2 (R2) and later reported to the facility staff, who alerted law enforcement.

An interview with staff #1 (S1) said they worked as the person in charge that day. They had heard resident #1 (R1) and resident #2 (R2) in an altercation near the elevator outside the dining area.

(Continuation on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 08-AS-20250403173506
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: BONITA VILLA SENIOR LIVING
FACILITY NUMBER: 374604544
VISIT DATE: 08/08/2025
NARRATIVE
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(Continuation of LIC9099)

When S1 went to see what the commotion was regarding, S1 found both R1 and R2 were face-to-face, confronting each other. S1 separated both R1 and R2, and they were directed to their rooms. S1 spoke with R1, who said R2 had hit them with a decorative figurine, which has since been removed. According to S1, they were informed that the incident had started earlier in the day, between R1 and Resident #3 (R3) during an activity. The facility had an activity that included the consumption of wine. According to S1, R1 usually attends this activity with friends, who bring their own alcohol. It had come to S1’s attention that R3 had made a comment to R1 regarding their heritage. According to an interview with R2, they said they had seen R1 argue with another unknown resident at the dining table, prior to leaving the dining area. After they left the dining area, they went to the elevator, and R1 called them an “asshole” and a “motherfucker.” R1 went towards them, with their motorized scooter, and ran into them while at the elevator. R2 then confirmed they retrieved a decorative ceramic figurine and hit R1 in the chin. R1 commenced to yell at them and then took the ceramic figurine with them so they can inform everyone what R2 had hit them with. R2 said that staff #3 (S3) came out of the employee’s lounge, and R2 informed them of the incident. Later, law enforcement came by to obtain statements, and since they defended themselves, they were not in trouble. According to Resident #3 (R3), they had seen R2 pouting in the dining area. When they asked what was wrong, they informed them that they had an incident with R1. Minutes later, R3 then accompanied R2 to their room, where law enforcement was waiting for them to obtain a statement. During this time, R1 passed by their room and did this approximately 3 times to intimidate them, but they were there to protect R2. Interviews were conducted with resident #4 (R4), who said they heard commotion but did not recall details.

A review of records revealed that, since 2023, the resident has had numerous documented altercations, inebriations, and acts of aggression toward other residents. Photos revealed the residents’ bruising. R2 had bruising to the inner thigh of their right leg. R1 had bruising to the bottom left side of their chin. The facility provided the resident and the RP with a violation notice of the rules, dated April 3, 2025. While a care conference had been scheduled with R1’s responsible party after the alleged incident, there were no documented attempts by the facility to address R1’s known aggression and/or behavioral expressions over the prior 2 years. LPA reviewed R1’s file again on August 8, 2025, and there were no updated information as to the updates to R1’s care plan. The Department requested law enforcement reports but there were no responsive records for this incident.

(Continuation on LIC9099-C)
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20250403173506
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: BONITA VILLA SENIOR LIVING
FACILITY NUMBER: 374604544
VISIT DATE: 08/08/2025
NARRATIVE
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(Continuation of LIC9099-C)

Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff and outside source interviews, and records reviewed, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099-D.

The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Abraham Botello, Executive Director. A copy of this report, along with Licensee/Appeal Rights (LIC9058 3/22), and immediate Civil Penalties were assessed and provided to Executive Director Botello at the conclusion of the visit. The signature below confirms the receipt of these documents.

This is an amended version to an original report delivered on 08/08/2025.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20250403173506
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: BONITA VILLA SENIOR LIVING
FACILITY NUMBER: 374604544
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2025
Section Cited
CCR
87466
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87466 Observation of the Resident The licensee shall ensure that residents are... observed for changes in physical, mental, emotional and social functioning and that... assistance is provided...
This requirement was not met as evidenced by:
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The facility plans to schedule a care conference with the family to update R1's plan of care, and aggreed to make a PCP appointment for an updated LIC602. The facility will inform LPA the scheduled dates by POC due date, 08/22/2025. The updated plan of care and LIC602 will be submitted to LPA once they are complete.
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Based on interview and record review, the licensee did not assist a resident with a history of aggression, resulting in a resident-on-resident altercation with injuries for 2 residents [R1 and R2], posing an immediate health, safety, and personal rights risk to 2 of 127 residents in care.
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This is an amended version to an original report delivered on 08/08/2025.
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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.
SUPERVISORS NAME: Jerry Romero
LICENSING EVALUATOR NAME: Robyn Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4