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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604820
Report Date: 10/01/2025
Date Signed: 10/01/2025 07:44:09 PM

Document Has Been Signed on 10/01/2025 07:44 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:NEW WORLD VILLA SOUTHFACILITY NUMBER:
374604820
ADMINISTRATOR/
DIRECTOR:		CHEN, ZAYDENFACILITY TYPE:
740
ADDRESS:14125 TARZANA RDTELEPHONE:
(858) 748-2888
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 5DATE:
10/01/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Med Tech Allan BartalomeTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct an additional continuation of the comprehensive required annual inspection that commenced on September 15, 2025. LPA identified herself to Med Tech Allan Bartalome (S1) and was granted entry into the facility. Staff Yasar (S2) later arrived at the facility and joined the inspection.

A review of staff records revealed there was no documentation on staff training, and an interview with S2, S1, and S3 confirmed staff had not received the required training prior to their starting date. The records review also revealed two (2) of the staff members were missing additional required records on file. An interview with S2 and a facility records review also showed staff had never participated in a disaster drill, could not provide an infection control plan, nor provide current liability insurance.

LPA, accompanied by S1, inspected the facility kitchen. LPA observed the facility kitchen to be unsanitary, including dead pests in the kitchen cabinets/drawers, and in need of deep cleaning. The inspection did reveal the facility had an adequate amount of food, that included a 2-day supply of perishable and 7-day supply of non-perishable food, and sharps (e.g., knives) were observed stored in a locked cabinet. LPA also observed all essential dishware and utensils needed for cooking and eating. In addition, the facility was equipped with smoke and carbon monoxide detectors, and fire extinguishers, that were all operable and/or up to date.

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Debbie Correia
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2025
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: NEW WORLD VILLA SOUTH
FACILITY NUMBER: 374604820
VISIT DATE: 10/01/2025
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A review of the resident Medication Administration Records (MARs) revealed Resident1 (R1) ran out of their daily heart medication on approximately July 15, 2025, and had not received a refill since, in addition, Resident 2 (R2), was going on the second day of missing their medication also due to running out and not receiving a refill. LPA observed the medications were stored in a locked medication cart, and medications that required refrigeration, were locked in a mini refrigerator.

LPA observed resident rooms and bathrooms to be equipped with the required furnishings and safety equipment. Water at taps used by residents measured in compliance with regulation. The facility has a large common area and outdoor shaded area for residents’ activities and visitation. Required licensing postings were in visible areas of the facility. No pools or bodies of water were on the premises. Per S2 there are no firearms or ammunition kept at the facility.

LPA concluded the required annual inspection during today’s visit, however, will be returning to issue citations for the above-described violations.

An exit interview was conducted with Staff Yasar (S2) to whom copies of this report and the Licensee/Appeal Rights (LIC9058 03/22) will be provided at the conclusion of the visit.

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Debbie Correia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
LIC809 (FAS) - (06/04)
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