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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603323
Report Date: 08/31/2026
Date Signed: 08/31/2026 02:54:40 PM

Document Has Been Signed on 08/31/2026 02:54 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:BARON'S PRESIDIO UNIVERSITY CITYFACILITY NUMBER:
374603323
ADMINISTRATOR/
DIRECTOR:		NARMINA MAMEDOVAFACILITY TYPE:
740
ADDRESS:6860 CONDON DRIVETELEPHONE:
(858) 558-4772
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY: 0CENSUS: 0DATE:
08/31/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:37 PM
MET WITH:Mailed to Licensee's AddressTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Manager sent this report to the licensee's last known address to cite a deficiency discovered during the course of an unrelated complaint investigation 08-AS-20251006104258, which was conducted by LPA Arian Golbaksh.

While conducting file review for the above mentioned complaint investigation, it was noted that a resident with a Dementia diagnosis (identified as R1) required special observation/night supervision. Per staff interviews and notes on R1 by the facility, they were a known fall risk and had behaviors of wandering day and night. One staff interview indicated that while there were staff present during the night, they were not consistently awake. Another staff member interviewed revealed that R1 would call for help when they had a fall and staff would then go to assist R1. This interview also revealed that staff began leaving lights on at night to assist R1 with their nighttime wandering, hoping it would decrease R1's number of falls. Other staff member interviews shared accounts of R1 wandering out the front door at night and causing verbal disturbances to the neighborhood and other residents in the home.

One outside source interviewed revealed concerns of there being no awake overnight staff, stating that administrative staff had initially informed them there would be but then shared that would be cut and only the live-in staff would be present. Another outside source interviewed shared that they made recommendations for 1:1 care for R1 but that the facility was unable to support that level of care with their staffing ratio.

One (1) deficiency was cited and immediate civil penalty assessed for a violation that results in the absence of required supervision for a resident [ See attached LIC 809 (d) and LIC 421 IM]. A copy of this report, LIC 809(d), LIC 421 IM, along with Licensee/Appeal Rights (LIC 9058) were delivered via certified mail to the licensee's last known address.

Jerry Romero
Robyn Clark
DATE: 08/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2026
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 08/31/2026 02:54 PM - It Cannot Be Edited


Created By: Robyn Clark On 08/31/2026 at 02:42 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: BARON'S PRESIDIO UNIVERSITY CITY
FACILITY NUMBER: 374603323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/31/2026
Section Cited
CCR
87705(b)(2)

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87705 Care of Persons with Dementia (b) Licensees shall be responsible for... (2) ...ensuring there is at least one night staff person awake and on duty... in addition to requirements specified in...Night Supervision. This requirement is not met as evidenced by:
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Facility is closed; POC is deemed cleared.
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Based on LPA interviews and file review, the licensee did not ensure awake night staff were present and on duty to provide a Dementia resident with overnight supervision as required, which posed an immediate health and safety risk to 1 out of 4 persons in care (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.
Jerry Romero
NAME OF LICENSING PROGRAM MANAGER:
Robyn Clark
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/31/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2026


LIC809 (FAS) - (06/04)
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