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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 02/12/2026
Date Signed: 02/12/2026 03:07:19 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
08/04/2025 and conducted by Evaluator Ramon Serrano
COMPLAINT CONTROL NUMBER: 08-AS-20250804140626
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: 112DATE:
02/12/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Abraham BotelloTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Reporting requirements were not met
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 Executive Director Abraham Botello.

The Department’s investigation consisted of interviews with staff, residents, outside sources and review of records.

LPA conducted an investigation into the allegation that reporting requirements were not met. It was reported that Resident 1 (R1) was found by their responsible party (RP) in their room in very poor condition. RP requested that R1 be sent to the hospital. RP stated they were never informed that R1 was sick or contagious.LPA interviewed an outside source (OS) who stated that they visited R1 several months ago and found them sick with COVID in their room. OS reported that the facility never called them to inform them of R1’s condition.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
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-20250804140626
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: 02/12/2026
NARRATIVE
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OS explained that medtechs were calling the wrong number and leaving messages. OS later learned that the medtechs had the correct number but were transposing digits when making calls. OS stated that in the past few months, everything has been fine with the facility and R1.

LPA interviewed R1, who stated that facility staff are in regular contact with RP. R1 confirmed that they had COVID some time ago and were sent to the hospital. R1 stated that staff advised RP about the COVID diagnosis. LPA interviewed the Resident Services Director (RSD), who stated that this incident occurred before they were hired. RSD explained that the medtech responsible for communication at the time was terminated and no longer works at the facility. RSD believed RP was informed of R1’s COVID diagnosis. RSD stated that an incident report was never generated or submitted to CCL.

LPA interviewed Staff 1 (S1), who stated that they never spoke directly with RP but left a voicemail requesting more disposable undergarments for R1. S1 recalled RP later saying they were never told about R1 having COVID when they came to visit.

LPA reviewed R1’s records and noted that R1 has a primary diagnosis of bladder cancer, is listed as having dementia, and their physical health status is documented as poor. Chart notes from March 2025 through October 2025 were reviewed. On August 1, 2025, notes show that R1 tested positive for COVID and that RSD and the Memory Care Director were notified. Later that same day, S1 documented that they informed RP about the need for more disposable undergarments. However, there is no clear documentation showing that RP was informed of R1’s COVID diagnosis.

Based on interviews and record review, there is evidence that R1 tested positive for COVID and was hospitalized. RP indicated they were not properly notified and facility staff confirmed that they never spoke directly to RP. An incident report was never submitted to CCL. 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 Business Office Manager Raymie Cruz A copy of this report, along with Licensee/Appeal Rights (LIC9058 3/22) was provided to Raymie Cruz 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: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20250804140626
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: 02/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/09/2026
Section Cited
CCR
87211(a)(1)(b)
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(a) Each licensee shall furnish to the licensing agency such reports as the Department may require...A written report shall be submitted to the licensing agency and to the person responsible for the resident...Any serious injury as determined by the attending physician...This requirement was not met due to:
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Licensee stated they will review title 22 regulations on reporting requirements and will conduct a staff training on reporting incidents to both CCL and residents' responsible parties. ED will submit to LPA training log by POC due date.
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R1 tested positive for COVID. Facility records show internal staff were notified, but RP was not informed of the diagnosis. CCL did not receive an incident report. Failure to notify RP of a significant change in condition violates reporting requirements and poses a health, safety and personal rights risk.
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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: 02/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
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