Rancho Santa Fe Villa.

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced Case Management visit regarding a deficiency cited on 4/27/26 as well as a Plan of Correction (POC) visit to follow-up on two (2) deficiencies cited 5/13/26. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Licensee/Administrator Ray Baha. On 4/27/26 during the facility's required annual inspection, LPA cited a deficiency for the facility locking exterior doors without having the fire clearance to do so. POC has since been met and the deficiency cleared (as of 5/22/26). However, as the violation was a Zero Tolerance Violation (ZTV), an immediate Civil Penalty of $500.00 has been assessed today as it was not assessed on the day of the deficiency on 4/27/26. Details are included on the attached LIC 421IM. On 5/13/26 LPA cited a deficiency for the facility having not met reporting requirements. POC due date was set for 5/22/26 and was: "Licensee will submit an incident report of the event to Community Care Licensing by POC due date. Licensee will review 87211 and submit to LPA by the POC due date the facility's plan to ensure ongoing compliance with reporting timelines moving forward." While the Department received an incident report on 5/15/26 for the incident that took place 4/24/26, LPA had not received the secondary POC item by the due date, nor communication from the Licensee requesting for an extension. As the Licensee failed to correct the deficiency and notify LPA by the due date, LPA conducted a POC visit to verify correction and to assess a Civil Penalty Violation for Failure to Correct. A Civil Penalty of $100.00 a day has been assessed from 5/23/26 through today's date 6/2/26 for a total of $1,100.00. Details are included on the attached LIC 421FC. Licensee was able to provide LPA POC items during the visit and LPA cleared the deficiency. POC clearance letter was provided to Licensee Baha. [Continued on LIC 809-C] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 [Continued from LIC 809] Additionally on 5/13/26 LPA cited a deficiency for the facility violating the right for residents to receive unopened correspondences. Please see complaint 08-AS-20260512093839 for additional information. POC due date was set for 5/15/26 and was: "Licensee will promptly provide any mail/correspondences for R1. Licensee will submit a written statement to LPA that they have provided R1 their packages and will continue to do so promptly for future packages. Licensee will submit proof to LPA by POC due date." LPA had not received POC items by the due date, nor communication from the Licensee requesting for an extension. As ten (10) working days have passed since the POC due date, LPA cannot issue a Civil Penalty for Failure to Correct. The deficiency is being re-cited today and details are included on the attached LIC 809-D page. Licensee was able to provide POC items during today's visit and LPA cleared the deficiency. LPA provided the POC clearance to Licensee/Administrator Baha. One deficiency was cited during today's visit along with two (2) Civil Penalty assessments. An exit interview was conducted with Licensee/Administrator Baha to whom a copy of this report, the two (2) POC clearance letters, the LIC 421IM, LIC 421FC, and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced Case Management visit to the facility. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Licensee/Administrator Ray Baha. While conducting interviews and file review, LPA was informed by staff of an incident regarding a resident "a few Friday's ago," in which the resident (identified as R1) had obtained alcohol via physical mail and consumed it. Per file review and staff interviews, R1 has a documented history of alcohol and substance abuse. LPA had additionally conducted an interview with an outside source responsible for R1's care and it was revealed that the incident occurred prior to May 6th, 2026 though no specific date of the incident had been given. Community Care Licensing (CCL) had not received any notification from the facility of any such incident within the required seven (7) days. A Type B deficiency for not meeting reporting requirements was issued, and details are included on the attached LIC 809-D page. LPA offered consultation for possible next steps regarding concerns that R1 may no longer be safely able to manage their mail. Licensee/Administrator Baha stated they do not believe the incident fell under the criteria of an incident requiring notification to CCL and requested this to be included in today's report. One Deficiency was cited during the visit. An exit interview was conducted with Licensee/Administrator Baha to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregivers Weny Labuguin and Angelita Hernandez. Administrator Ray Baha arrived shortly after LPA. The facility's license shows a maximum capacity of six (6) non-ambulatory residents. Bedrooms #1, #4, #5, and #6 are approved for bedridden. Additionally, the facility is approved for a hospice waiver for six (6). During today’s inspection there were four (4) residents in care, with none currently on hospice. Note, LPA did step out from 12:50-1:50 for lunch. LPA and Administrator Baha toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: common bathroom sink adjacent to bedroom #7 was 107.2F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and inaccessible to residents. While looking at the unlocked cabinet under the sink, LPA observed a number of cleaning chemicals. One type A deficiency was issued for the accessible chemicals to residents. Staff immediately moved the items to a locked storage room. [Continued on LIC 809-C] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 [Continued from LIC 809] Additionally, while touring the enclosed courtyard at the center of the home, LPA was shown the doorway to the garage area. LPA observed that the door was only lockable from the inside and was currently unlocked. Inside the garage were a number of chemicals, in addition to an accessible door into the medication/chemicals storage room. Per Administrator Baha, the facility was in the process of changing several locks (garage door included) in the home so that they are all accessible by the same key for efficiency. Administrator Baha locked the doorway from the inside and exited through the lifting garage door so that the garage was no longer accessible to residents. LPA observed that the doors to the enclosed courtyard space were unlocked, allowing for resident access. However, the exterior doors of the home leading outside were all locked aside from the front door and required a key to open. The facility does not have approval for locked exterior doors and/or a locked perimeter. Administrator Baha explained that the exterior yard is not safe for resident use and the enclosed courtyard is the designated outdoor space for resident use. One type A deficiency was cited for the unapproved locked exterior doors. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator Baha, no firearms or ammunition are kept at the facility. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months, dated for February 2026. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA observed a private care aid (identified as S1) who was present at the facility for their assigned resident (identified as R1). LPA requested S1's background clearance from the facility for review and was informed that they did not have it on file. Per interview with S1, it was revealed S1 was not employed by a private care agency. Upon review of the Guardian background check database, it was revealed that S1 had not undergone the LiveScan process (fingerprint submittal and background check). One Type A deficiency was issued for S1 providing care and supervision services on the premises without a required background check. LPA ensured S1 was escorted off the premises. [Continued on LIC 809-C] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 [Continued from LIC 809-C] While at the facility, LPA observed five (5) camera monitor systems displaying common facility areas and the inside of four (4) resident rooms, along with audio from each space. Per Administrator Baha, the responsible parties of the residents were aware of the use of cameras in private spaces and gave permission. While the use of surveillance cameras are not expressly prohibited in Title 22 regulations, efforts to protect resident privacy must be maintained by the facility and a waiver request must be submitted to the Department for camera use in private resident rooms. An audio component for video surveillance in facilities is strictly prohibited. One Type B citation was issued for the use of video and audio surveillance in private areas of the facility without Department approval. Administrator Baha turned off all five monitors. LPA interviewed two (2) staff and one (1) clients, and interviews did not reveal any additional licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. LPA noted consent forms signed by resident responsible parties included in the files of only three (3) of the four (4) resident rooms that contained cameras. Four (4) deficiencies were cited during the inspection. An exit interview was conducted with Administrator Baha to whom a copy of this report, the LIC 421BG form, and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced case management visit to address a deficiency discovered during a complaint investigation. The LPA identified himself and disclosed the purpose of the visit to Administrator Ray Baha. During a complaint investigation, it was revealed staff had not assisted residents with incontinence care. Review of records revealed several residents in care required assistance with toileting and incontinence care. The administrator confirmed several residents required assistance with toileting/ incontinence care and that staff assisted these residents with this care. Although staff reported providing care during the night shift, conducted random checks, and residents could call for assistance; Interviews with internal and external sources corroborated staff did not ensure incontinence residents were kept clean and dry. One source reported witnessing Resident # 1 (R1) with soiled incontinence briefs. An interview with an additional source revealed staff would only check on R1 once per night, and this had resulted in R1 sitting in soiled incontinence briefs. An additional source reported staff did not respond to assist Resident # 2 (R2) with briefs changes resulting in R2 wearing soiled briefs. This deficiency was cited in accordance with California Code of Regulations, Title 22, and cited in an LIC 9099-D form. A plan of correction was jointly formulated with the administrator. An exit interview was conducted with Ray Baha, to whom a copy of this report, and Licensee/Appeal Rights (LIC9058), were provided.

These interviews, including the administrator and S1, corroborated S1 was asked to work for the facility for two days, while regular care staff were off. Review of the Department’s background clearance database revealed S1 was not associated to the facility and did not have a background clearance. Based on the evidence obtained, the deficiency was cited in an LIC 9099-D form. An immediate two hundred dollar ($200) civil penalty was assessed in an LIC 421BG form. It was alleged required postings were not visible. It was reported to the Department the required postings, including the Department’s “If you see something, Say something” poster, were posted in a section of the facility the residents did not use. Interviews with staff, including the administrator, confirmed the section of the facility where the postings were was not regularly used by residents. The area was used for meetings. The LPA observed some of the postings were not visible. The deficiency was cited in an LIC 9099-D form. It was alleged the facility did not conduct emergency drills. It was reported to the Department residents had not participated in emergency drills. Interviews with several staff revealed the facility conducted drills every three months. The type of drills varied between fire, and earthquake emergencies. Review of records revealed the facility documented the date of the drill, and staff who participated, but not the time. An interview with the administrator revealed the facility did not conduct drills on every scheduled shift. Per regulations, the residents are not required to participate in emergency drills, but the facility must conduct drills at least quarterly for each shift. This deficiency was cited in an LIC 9099-D form. Plans of Corrections (POCs) were jointly formulated with Administrator Baha. An exit interview was conducted with Baha, to whom a copy of this report, LIC 9099D forms, LIC 421BG, LIC 811, and Licensee/Appeals Rights (LIC 9058), were provided.