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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604544
Report Date: 04/27/2026
Date Signed: 04/27/2026 04:07:01 PM

Document Has Been Signed on 04/27/2026 04:07 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: 95DATE:
04/27/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Abraham BotelloTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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LPA Serrano arrived at the facility to deliver a case management investigation report related to a fall experienced by Resident 1 (R1) on 10/20/2025 and concerns regarding the facility’s response, medical assessment practices, supervision, and change in condition procedures. LPA met with Executive Director Abraham Botello and discussed the purpose of the visit.

R1 moved into the independent living area on 10/28/2020 and did not require assistance with daily activities at the time of admission. On 10/20/2025, R1 contacted the front desk and requested help after they fell inside their room. Staff 1 (S1) responded and helped R1 up from the floor. S1 stated that R1 reported hitting their head during the fall. S1 reported that R1 appeared to have no visible injuries and reportedly refused medical care. Staff 2 and Staff 3 also responded to the call but did not enter the room or assess R1 for injuries.

The Department interviewed the Administrator, who stated they believed R1 had no fall history prior to the 10/20/2025 incident. The Department reviewed R1’s facility records and identified a total of nine falls dating back to January 2024. All but one occurred in R1’s room and were unwitnessed. Three of these falls resulted in hospital transport for serious injuries, including hip injuries. Records also indicated R1 hit their head in at least two prior falls. Additional documentation showed multiple hospital transports for breathing issues and other medical conditions. The only Physician’s Report available was dated 10/1/2020, with no updated assessments on file.

The Department conducted a follow-up interview with the Administrator. The Administrator stated they had only been in their role for a few months and were unaware of R1’s fall history.

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Ramon Serrano
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2026
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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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: 04/27/2026
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The Department asked whether R1 had been re-evaluated given their repeated falls and clear changes in condition. The Administrator confirmed that no updated medical assessments existed. The Department advised the Administrator that based on the frequency of falls, injuries, and medical needs, R1 should have been considered for a higher level of care such as assisted living. The Administrator agreed.

The Department’s review concluded that R1 had not been medically re-evaluated since 10/1/2020, despite multiple falls and significant medical concerns. The facility did not take steps to reduce R1’s fall risk or request a higher level of care.

The Department reviewed the facility’s response to R1’s fall on 10/20/2025. S1 reported that R1 stated they hit their head. S2 and S3 responded but did not enter the room or assess R1. S1 1 claimed R1 refused medical treatment. S2 instructed S1 to monitor R1 every hour for any change in condition.

The Administrator stated that while the facility has no written policy on suspected head injuries, staff are instructed to call 911 when a resident hits their head or is suspected of hitting their head. S3 confirmed this expectation.

The Department interviewed R1. R1 stated they told S1 they hit their head hard and that their head and right side were hurting. R1 stated S1 did not assess them and that they did not refuse medical care. R1 stated they remained in their room for two days in pain until they contacted the front desk again. Facility records show that on 10/22/2025, S3 called 911 after R1 asked for help.

The Department reviewed documentation and found no recorded hourly checks between 10/20/2025 and 10/22/2025, despite staff claiming these checks were performed. R1 also reported no staff checked on them during these dates. S3 confirmed that such monitoring should have been documented.

Based on the information reviewed, the Department determined that the facility did not provide timely medical attention and did not conduct required monitoring after a reported head injury. The Department concluded that the facility failed to provide care and supervision, failed to observe and document changes in condition, and did not meet Title 22 RCFE requirements. Deficiencies were cited on LIC 809-D. An exit interview was conducted and a copy of this report along with the Licensee's Rights (LIC9058 03/22) was provided to Abraham Botello signature on this form confirms receipt of these documents.

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Ramon Serrano
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 04/27/2026 04:07 PM - It Cannot Be Edited


Created By: Ramon Serrano On 04/27/2026 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: 04/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/28/2026
Section Cited
CCR
87101(c)(3)

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"Care and Supervision" means those activities which if provided shall require the facility to be licensed. It involves assistance as needed with activities of daily living and the assumption of varying degrees of responsibility for the safety and well-being of residents...This requirment was not met as evidenced by.
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The facility will retrain all caregivers and Med-Tech staff on fall response, suspected head injury protocol, and required documentation.• Training will be completed by [POC due date].• A copy of the training agenda and staff signatures will be submitted to CCL by 4/28/26
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The facility did not supervise R1 properly when they reported hitting their head. Staff did not assess R1, did not call 911 for a suspected head injury, and did not complete or document hourly monitoring checks. This posed an immediate health and safety risk to R1.
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Type A
04/28/2026
Section Cited
CCR87458(b)

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(b) The licensee shall obtain an updated medical assessment when required by the Department. This requirement was not met as evidenced by;
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• The facility will immediately obtain an updated medical assessment for R1.• The Administrator will implement a tracking system to ensure all residents receive timely updated assessments.• Proof of the updated assessment and tracking system will be provided to CCL by 4/28/26.
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R1’s last medical assessment was dated 10/1/2020. The facility did not obtain updated assessments despite repeated falls, hospitalizations, and changes in condition. This posed an immediate health and safety risk to R1.
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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: 04/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/27/2026 04:07 PM - It Cannot Be Edited


Created By: Ramon Serrano On 04/27/2026 at 10:43 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: 04/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/28/2026
Section Cited
CCR
87463(e)(1)

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(e) The licensee shall immediately, or as soon as reasonably possible, bring any significant change in condition... to the attention of the appropriate licensed medical professional... Documentation of such communication shall be added...This requirement was not met as evidenced by;
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 The facility will complete a written reappraisal for R1.• The Administrator will create a system to ensure reappraisals are completed after any significant change in condition.• Verification of completion will be submitted to CCL by 4/28/26.
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The facility did not conduct reappraisals for R1 despite nine falls, multiple injuries, and hospitalizations, all of which constitute significant changes in condition. This posed an immediate health and safety risk to R1.
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Type A
04/28/2026
Section Cited
CCR87468.1(a)(16)

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Residents in all residential care facilities for the elderly shall have all of the following personal rights:(16) To receive or reject medical care or other services. This requirement was not met as evidenced by.
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The facility will create and implement a written fall and head injury response policy.• All staff will be trained on the new policy.• Proof of policy implementation and staff training will be submitted to CCL by 4/28/26.
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R1 did not receive timely medical evaluation or safe and healthful care after reporting a head injury. Staff failed to provide proper assessment and supervision. This posed an immediate health and safety risk to R1.
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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: 04/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2026


LIC809 (FAS) - (06/04)
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