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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374605021
Report Date: 09/08/2026
Date Signed: 09/08/2026 01:49:54 PM

Document Has Been Signed on 09/08/2026 01:49 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 LOVING CARE - UCFACILITY NUMBER:
374605021
ADMINISTRATOR/
DIRECTOR:		NORTON, AGNIESZKAFACILITY TYPE:
740
ADDRESS:6860 CONDON DRTELEPHONE:
(858) 558-4772
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY: 6CENSUS: 5DATE:
09/08/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:31 PM
MET WITH:Staff, Esther VillarTIME VISIT/
INSPECTION COMPLETED:
01:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Case Management - Deficiencies visit. LPA identified herself and was allowed entry into the facility by Staff, Medenio Villar. Staff, Esther Villar arrived during.

LPA was at the facility to conduct a complaint investigation and observed deficiencies. Upon arrival, LPA observed the garage that stored chemicals had a padlock, that was unlocked, making it accessible. Staff were inside the facility and the garage was unattended. A review of the facility's freezer reflected a package of meat that had torn plastic, allowing air exposure to the meat. The meat had freezer burn from the exposure. There were other meat products not in their original packaging without labels or dates to indicate what the items were. Resident #1 (R1) had some unusual incidents that occurred at the facility to include, a medical condition requiring attention. Staff contacted 911 but R1 refused transport. The paramedics were also contacted a week later for the same medical condition, which R1 refused again. On a different day, R1 was transported by their Power of Attorney to the hospital. In addition, R1 wandered outside of the facility and down the street, staff had line of sight supervision. R1's Physician's Report dated 07/17/26, indicated R1 was not allowed to leave the facility unassisted. However, none of the incidents involving R1 was reported to Community Care Licensing. LPA requested the Medication Administration Records (MARs) for R1. However, staff did not have any for R1. LPA requested to review the MARs for the other residents. Staff brought the MARs for August 2026. LPA requested the current MARs for September 2026 for the other residents. Staff was taking a prolonged period of time to provide the records. Therefore, LPA went to inquire about the delay and observed staff completing the MARs for September by initialing their name in the boxes. Staff stated medications were administered for September 2026 but they did not complete the MARs when they administered the medications. Staff initialed the boxes for September with the assumption all the previous medications were dispensed due to not completing the MARs when the medications were actually dispensed. Continued on LIC 809C.
Lizzette Tellez
Natasha Persaud
DATE: 09/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2026
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: BARON'S LOVING CARE - UC
FACILITY NUMBER: 374605021
VISIT DATE: 09/08/2026
NARRATIVE
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In addition, a review of R1's Physician's Report dated 07/17/26, indicated R1 was ambulatory but did not have the capacity for self care, regarding bathing, dressing/grooming, feeding, toileting, cash resources, and medication management which was a prohibited health condition. The licensee did not submit an exception request prior to admitting R1 to the facility. In addition, the report reflected R1 was unable to follow directions, and unable to communicate, and it did not have a primary diagnosis.

Deficiencies were observed and cited on the attached LIC 809D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Staff, Esther Villar whose signature below confirms receipt of these rights.
NAME OF LICENSING PROGRAM MANAGER: Lizzette Tellez
NAME OF LICENSING PROGRAM ANALYST: Natasha Persaud
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 09/08/2026 01:49 PM - It Cannot Be Edited


Created By: Natasha Persaud On 09/08/2026 at 12:46 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 LOVING CARE - UC
FACILITY NUMBER: 374605021

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2026
Section Cited
CCR
87309(a)

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Storage Space and Access. Except as specified...the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances...and other similar items which could pose a danger...locked storage and are not left unattended if outside the locked storage.
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Staff locked the garage during the visit, removing the immediate threat. In addition, staff will attend training on ensuring chemicals and items that can pose a danger are inaccessible to residents. Proof of training will be submitted by POC due date.
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This requirement is not met as evidenced by:
Based on observations, the licensee did not ensure cleaning solutions were locked and/or unattended for 5 out 5 residents [R1-R5], which posed a potential health and safety risk to residents in care.
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Type B
09/15/2026
Section Cited
CCR87555(b)(9)

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General Food Service Requirements. Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement is not met as evidenced by:
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Staff disposed of meat that was freezer burned due to air exposure. In addition, all staff will attend training on food storage and provide proof of training by POC due date.
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Based on observations, the licensee did not ensure food was properly stored for 5 out 5 residents [R1-R5], which posed a potential health and safety risk to 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.
Lizzette Tellez
NAME OF LICENSING PROGRAM MANAGER:
Natasha Persaud
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/08/2026 01:49 PM - It Cannot Be Edited


Created By: Natasha Persaud On 09/08/2026 at 01:14 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 LOVING CARE - UC
FACILITY NUMBER: 374605021

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2026
Section Cited
CCR
87211(a)(1)(D)

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Reporting Requirements. A written report...within seven days of the occurrence...(A) through (D) below. This report...and disposition of the case. Any incident...resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by:
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Administrator and staff will attend training regarding reporting requirements and submit proof of training by POC due date.
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Based on interviews and record review, the licensee did not submit incident reports involving 1 out of 5 residents [R1], which posed a potential health and safety risk to residents in care.
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Type B
09/15/2026
Section Cited
CCR87506(a)

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Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information. This requirement is not met as evidenced by:
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Administrator and staff that assist with record keeping will attend training and provide proof of training by POC due date.
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Based on record review and interviews, the licensee did not ensure records were accurately maintained for 5 out 5 residents [R1-R5], which posed a potential health and safety risk to 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.
Lizzette Tellez
NAME OF LICENSING PROGRAM MANAGER:
Natasha Persaud
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2026


LIC809 (FAS) - (06/04)
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