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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604544
Report Date: 12/22/2025
Date Signed: 12/22/2025 03:13:23 PM

Document Has Been Signed on 12/22/2025 03:13 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:BONITA VILLA SENIOR LIVINGFACILITY NUMBER:
374604544
ADMINISTRATOR/
DIRECTOR:		REBECCA TOVESFACILITY TYPE:
740
ADDRESS:3434 BONITA ROADTELEPHONE:
(619) 476-9444
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 145CENSUS: 99DATE:
12/22/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:29 AM
MET WITH:Richard TibiTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Case Management Visit.  LPA was greeted by and met with Resident Services Director Richard Tibi, to discuss the purpose of the visit. 

Today's visit is in response to the self reported incident involving Resident 1 (R1- see LIC811 Confidential Names List) who eloped from the facility and was found later that same day in La Mesa.

An Incident report was submitted to CCLD reporting the following: On 10/03/2025 at approximately 9:30 AM, staff conducted a routine check and discovered that Resident 1 (R1) was not in their room. Staff immediately began searching inside and outside the facility. During the search, a staff member who was on break informed the Executive Director (ED) that they saw R1 a few blocks away from the facility. After about one hour of unsuccessful searching, staff notified R1’s Power of Attorney (POA) and contacted the Sheriff’s Department to report the incident. The Sheriff’s Department initiated a search; however, R1 was not located at that time. At approximately 7:50 PM, a staff member received a call from a Transit Security Officer stating that they had R1 at the trolley station in La Mesa on Spring Street and La Mesa Boulevard. The officer reported that R1 was very intoxicated and had shown them the facility’s business card, stating, “That is where I live.” After receiving this information, staff contacted the ED, who immediately went to pick up R1. R1 returned to the facility around 9:00 PM. The POA was notified, and R1’s primary care physician was also informed.

On 12/22/2025, LPA interviewed R1 in the facility’s patio area. R1 was well-groomed and appropriately dressed. R1 stated that prior to the incident, they believed they had a stroke and had gone to the hospital several times to get checked. On the day of the incident, R1 said they intended to visit their spouse and child’s graves at Glen Abbey Cemetery.
NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Ramon Serrano
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2025
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: BONITA VILLA SENIOR LIVING
FACILITY NUMBER: 374604544
VISIT DATE: 12/22/2025
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After visiting, they took a bus and ended up at Fashion Valley Mall. R1 then boarded a trolley, thinking it would take them back to Chula Vista, but they ended up in La Mesa. R1 stated that they told an officer they were lost and showed the officer the facility’s business card. The officer then contacted the facility, and the ED picked R1 up. R1 believes they may have had a stroke that caused confusion that day and stated they were checked out and are doing well now.

LPA reviewed R1’s records. According to the physician’s report dated 08/05/2025, R1 has mild cognitive impairment, hypertension, and a history of alcohol use disorder. R1 is not permitted to leave the facility unsupervised and is disoriented to time and date.

LPA interviewed Executive Director (ED) who stated that on the date of the incident R1 eloped during lunch service. ED stated that R1 usually sits near the front door of the facility and believes that due to lack of supervision R1 was able to exit the building and walk away from the facility.


Based on the information obtained, the facility did not ensure that R1 remained under supervision as required. This poses a potential health and safety risk to residents in care.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), was provided to Richard Tibi at the conclusion of the visit. The signature below confirms the receipt of these documents.
NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Ramon Serrano
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/22/2025 03:13 PM - It Cannot Be Edited


Created By: Ramon Serrano On 12/22/2025 at 12:13 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: BONITA VILLA SENIOR LIVING
FACILITY NUMBER: 374604544

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/23/2025
Section Cited
CCR
87468.2(a)(4)

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...residents in ... residential care facilities for the elderly shall have all of the following personal rights:To care, supervision... that meet their individual needs and are delivered by staff that are sufficient in numbers... and competency to meet their needs. This requirement was not met as evidenced by:
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Licensee stated that after the incident R1 was placed on "care plan" and is checked on 3-4 times per shift. The Licensee will also conduct a Staff training on elopement prevention and emergency response. Facility will submit plan to LPA by POC due date.
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R1 who has mild cognitive impairment and is not permitted to leave the facility unsupervised, was able to leave the facility. R1 was located several hours later by an Officer in La Mesa. The facility did not ensure proper supervision, which posed an immediate health and safety risk to R1.
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Proof of staff training and updated policies must be submitted to the Department by POC due date.

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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.
Robyn Clark
NAME OF LICENSING PROGRAM MANAGER:
Ramon Serrano
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2025


LIC809 (FAS) - (06/04)
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