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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 09/15/2025
Date Signed: 09/15/2025 05:13:12 PM

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
07/22/2025 and conducted by Evaluator Ramon Serrano
COMPLAINT CONTROL NUMBER: 08-AS-20250722163151
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: 114DATE:
09/15/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Richard TibiTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Lack of supervision resulted in resident being assaulted by another resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver complaint findings. LPA introduced himself and disclosed the purpose of the visit with Resident Services Director Richard Tibi.

Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of LPA observations, records review, interviews with staff and residents.

It was alleged that lack of supervision resulted in a resident being assaulted by another resident. It was reported that on July 21, 2025 Resident 1 (R1) attacked Resident 2 (R2) resulting in a laceration on their arm.

Review of R1's Physician's report dated October 10, 2024 revealed R1 has mild cognitive impairment and cannot leave the facility unassisted. R1 can be fiercely independent and does not like being restricted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
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-20250722163151
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: 09/15/2025
NARRATIVE
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LPA reviewed R1's charting notes dated October 15, 2024 through July 21, 2025. On October 15, 2024 R1 "chased" another resident to the lobby area and harassed them due to the resident reading outside of their room, which R1 did not like. On November 23, 2024 R1 was verbally abusive towards staff regarding R1's dinner. R1 chased after staff and yelled at them. On June 13, 2025 R1 became very aggressive with another resident due the other resident "humming." R1 told the resident that R1 would "slap" them in the face if they continued to hum.

LPA Interviewed R1 who stated that they have lived at the facility less then a year. R1 stated that although they only have a few friends at the facility, they do know every resident by their face. R1 stated that just prior to speaking with LPA they accidentally sat down next to a resident that they previously had a minor disagreement with. R1 explained that they asked the other resident if they were the one they had a disagreement with earlier in the day. R1 stated that the resident said "yes" and they both laughed. R1 denied having any altercations, disagreements or aggression towards other residents in the past. R1 stated that if they are ever annoyed with another resident they just ignore them and forget about it.

LPA interviewed R2 who stated that on the date of the incident they recall arguing with R1. R2 stated that they could not remember what they were arguing about. R2 stated that R1 came up to them and "twisted their arm off" R2 stated that after R1 hit them, R1 had an angry look in their eyes that frightened R2 and R2 thought they were going to come back after them, but they didn't. R2 stated "I just think that R1 is an angry, angry person. R2 stated that R1 has a history of being aggressive and angry with other residents, R2 stated that an incident occurred in the past where R1 became aggressive with another resident but R2 could not recall what exactly happened and who the resident was since it occurred a while back.

LPA interviewed Resident 3 (R3) who stated that they witnessed the incident that occurred on July 21, 2025. R3 stated that R1 was talking to them in the lobby area when R1 stopped turned to R2 and stated " we are having a private conversation, I'm talking to my friend." R2 said something and R1 yelled "what did you say?" R3 stated that R1 began to "tussle" with R2. R3 stated that the facility staff then came and separated R1 and R2. R3 stated that R1 has been aggressive with other residents in the past. R3 stated that R1 argued with another resident because they were whistling and it upset R1.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20250722163151
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: 09/15/2025
NARRATIVE
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LPA interviewed Staff 1 (S1) who stated that they were informed that on the date of the incident R1 became aggressive towards R2. S1 stated that R1 grabbed R2's arm resulting in a arm injury. S1 stated that after the incident R1's family promised that they would provide R1 with a private caregiver. S1 stated that R1's private caregiver was only seen for two to three days and they never returned. S1 stated that after a recent incident of elopement they spoke with R1's responsible party informing them that R1 needed a higher level of care. S1 stated that R1's responsible party is in the process of finding new placement for R1.

LPA reviewed a San Diego Sheriff's incident report (SDSIR) dated July 21, 2025. SDSIR indicated that R1 initiated a physical altercation with their neighbor R2 at their shared elderly care facility. SDSIR stated that R1 grabbed R2's forearms, resulting in a severe laceration to R2's right forearm. R2 was transported to a local hospital for medical treatment. Both residents were described as having mental cognitive deterioration. Staff members at the facility described R1 as having cognitive deterioration. Based on the statements collected, the injury to R2's arm, and the totality of the circumstances, R1 was placed on a 5150-hold pending psychiatric evaluation. Had R1 been left at the residential facility, it is believed that R1 would have likely continued being a danger to other residents and staff members.

Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during interviews and records review, 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 Resident Services Director Richard Tibi. A copy of this report, along with Licensee/Appeal Rights (LIC9058 3/22), and immediate Civil Penalties were assessed and provided to Richard Tibi at the conclusion of the visit. The signature below confirms the receipt of these documents.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20250722163151
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: 09/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/16/2025
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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Licensee stated that they would conduct an online training regarding resident aggression and dementia behaviors. Licensee will submit the training date and outline by 9/16/25. LIcensee stated that R1's POA is in the process of transferring R1 to a higher level of care facility.
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Based on interviews and record review, the licensee did not assist a resident with a history of aggression, resulting in a resident-on-resident altercation causing injury to 1 resident [R1], posing an immediate health, safety, and personal rights risk to 1 of 114 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.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4