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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604544
Report Date: 04/15/2026
Date Signed: 04/15/2026 03:59:16 PM

Document Has Been Signed on 04/15/2026 03:59 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: 96DATE:
04/15/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Abraham BotelloTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
NARRATIVE
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On 4/14/2026 LPA Ramon Serrano arrived to the facility to conduct a case-management deficiencies visit. LPA was greeted by Executive Director Abraham Botello and LPA explained the purpose of the visit.

On 4/6/2026, the Department conducted a case management visit to follow up on the self-reported death of a Resident (R1) [see 811 confidential names list]. During the visit, records were requested, however, three of the requested records could not be provided to the Department as required. An interview was conducted with the Executive Director (ED) who clarified that three records were not available due to the Resident Services Director (RSD) being out of the facility. The records included R1’s Preplacement Appraisal, LIC602 Physician’s Reports, as well as Caregiver Work Schedules for the months of January, February, and March.

On 4/14/2026 the department conducted a review of records that were obtained and identified that R1 was bedridden (R1). Interview conducted with ADM who believed R1 was bedbound. R1’s Needs and Service Plan update for Grooming dated 2/20/2026 was reviewed and indicated “Resident is Bed Bound.” A review of the facility narrative charting notes that on 9/3/2025, it was documented that R1 required repositioning every two hours to prevent bed sores. A review of the facility file was conducted on 4/14/2026 which revealed that the facility was licensed for 145 non-ambulatory residents, and 0 bedridden residents. During today’s visit, a health and safety visit was conducted which revealed that there were four (4) bedridden residents present.

Three (3) citations were issued and can be found on the attached LIC 809(D). Per California Health and Safety Code §1569.49 (c)(2)(A), a $500 immediate civil penalty was also assessed for a violation of the facility’s fire clearance [see attached LIC 421-IM]. An exit interview was conducted with Executive Director Abraham Botello, to whom a copy of this report, the LIC809-D page, the LIC421-IM page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Ramon Serrano
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2026
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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Document Has Been Signed on 04/15/2026 03:59 PM - It Cannot Be Edited


Created By: Ramon Serrano On 04/15/2026 at 10:14 AM
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: 04/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/16/2026
Section Cited
CCR
87202(a)(b)

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87202 Fire Clearance (a). All facilities shall maintain a fire clearance… Prior to … retaining any of the following types of persons, the… licensee shall notify the licensing agency and obtain an appropriate fire clearance… (2) Bedridden persons
This requirement was not met as evidenced by:
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Licensee stated they will submit an LIC200/bedridden application and facility sketch to CCL and contact the Fire Department by POC due date.
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Based on interview and record review, the licensee retained 1 Residents (R1-) without an approved fire clearance. This posed an immediate Health, Safety and personal rights risk to 1 of 96 Residents in care.
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Type A
04/16/2026
Section Cited
CCR87506(a)

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87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff
This requirement was not met as evidenced by:

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Licensee stated they will submit the requested records by POC due date. Licensee stated in the future they will submit records on the same day or within 24 hrs.
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Based on observation and interview, the licensee did not ensure that two records for one resident (R1) were readily available for facility and licensing staff. This posed a potential health safety and personal rights risk to 1 of 96 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.
Robyn Clark
NAME OF LICENSING PROGRAM MANAGER:
Ramon Serrano
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/15/2026 03:59 PM - It Cannot Be Edited


Created By: Ramon Serrano On 04/15/2026 at 10:24 AM
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: 04/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/16/2026
Section Cited
CCR
87412(f)

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87412(f)All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours.
This requirement was not met as evidenced by:

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Licensee provided LPA with staff schedules that were previously requested. Licensee stated in the future they will provide records immediately if not within 24 hrs.
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Based on observation and interview, the licensee did not ensure that staffing schedules for January, February and March of 2026 were readily available for the licensing agency to inspect. This posed a potential health safety and personal rights risk to 1 of 96 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.
Robyn Clark
NAME OF LICENSING PROGRAM MANAGER:
Ramon Serrano
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2026


LIC809 (FAS) - (06/04)
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