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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604820
Report Date: 05/11/2026
Date Signed: 05/11/2026 11:24:35 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/06/2025 and conducted by Evaluator Becky Kennedy
COMPLAINT CONTROL NUMBER: 08-AS-20251106144027
FACILITY NAME:NEW WORLD VILLA SOUTHFACILITY NUMBER:
374604820
ADMINISTRATOR:CHEN, ZAYDENFACILITY TYPE:
740
ADDRESS:14125 TARZANA RDTELEPHONE:
(858) 748-2888
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 4DATE:
05/11/2026
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Vicky BayaniTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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False statements
Licensee did not follow reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kennedy conducted an unannounced visit to conclude a complaint investigation. Upon arrival, LPA was greeted by Vicky Bayani, identified herself, and was granted entry into the facility. LPA met with Vicky Bayani, to whom the purpose of the visit was explained.

The Department’s investigation included staff and outside source interviews, as well as a review of facility and external records.

On November 6, 2025, the Department received a complaint alleging that the Licensee made false statements and failed to meet reporting requirements. These allegations stemmed from a prior complaint received on October 29, 2025, which alleged thefts committed by Staff 1 (S1) involving Resident 1 (R1), Staff 2 (S2), Staff 3 (S3), and facility belongings.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jerry Romero
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 08-AS-20251106144027
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 05/11/2026
NARRATIVE
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The complaint filed on October 29, 2025, was investigated and determined to be substantiated. As a result, the Department issued a lifetime exclusion prohibiting S1 from employment at any state licensed facility.

During the October 29, 2025, complaint investigation, interviews and record reviews indicated that the Administrator (ADM) and Licensee were aware of thefts committed by S1. An interview with S2 revealed that staff had noticed missing belongings, including jewelry belonging to R1 and S3. S2 also reported their personal credit card had gone missing.

Interviews with S2 and Staff 4 (S4), along with corroborating records, confirmed that the ADM and Licensee had knowledge of the thefts, which were not reported to the Department. Record reviews included written communication from the ADM directing S1 to return stolen items. These items were subsequently returned to the facility and to the rightful owners.

Records dated November 6, 2025, documented the Licensee sending a message to the ADM regarding the identification number (IMEI) of the stolen facility phone to confirm that the phone returned by the individual who purchased it from S1 was, in fact, the phone that belonged to the facility. In the same communication, the Licensee informed the ADM that the phone “did not matter anymore” because both the phone and the phone number had been removed from their records. Additionally, during a collateral visit conducted on November 6, 2025, S4 corroborated that the Licensee had knowledge of S1’s thefts.

On August 28, 2025, the Department conducted an unannounced facility visit and subsequently held an office meeting with the Licensee and S4 at the San Diego Regional Office (SDRO). During the meeting, the Licensee was questioned regarding the Change of Ownership (CHOW) application received by the Department on 9-8-25. When asked whether they had followed CHOW procedures and protocols required by state mandate, the Licensee stated they were unaware of the requirements. On December 17, 2025, the Department received a letter from the Licensee stating they had no knowledge of any thefts and that they had relinquished ownership of the facility to the ADM in May 2025.

SUPERVISORS NAME: Jerry Romero
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 08-AS-20251106144027
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 05/11/2026
NARRATIVE
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During a collateral interview, S4 reported receiving a phone call from the Department in June 2025 regarding the CHOW application submitted by the Licensee. S4 stated they had no prior knowledge that the Licensee had submitted the application in May 2025. S4 also stated that immediately after receiving the Department’s notification, they discussed CHOW requirements with the Licensee, outlined the mandated steps, and asked the Licensee whether they had complied. This included verifying whether the Licensee had issued written notification to residents and/or Responsible Parties (RPs) and the Department regarding the intent to sell the facility. Subsequently, on June 26, 2026, the Department received an email from the Licensee disclosing the facility will be undergoing a CHOW that will go into effect in 60 days.

An interview with Outside Source 1 (OS1) further revealed that the Licensee had previously been informed of CHOW procedures and requirements when they acquired two facilities via CHOW in May 2021. This information contradicts the Licensee’s statement made during the August 28, 2025, office meeting, claiming they were unaware of CHOW requirements.

Per Title 22, California Code of Regulations (CCR), Division 6, Chapter 8, Section 87109, the Licensee is required to comply with the provisions of Health and Safety (H&S) Code 1569.191, which establishes requirements for the sale or transfer of a licensed Residential Care Facility for the Elderly (RCFE). H&S Code 1569.191 requires a Licensee intending to sell or transfer the facility property or business must provide written notice to the Department and to each resident or their legal representative at least 30 days prior to the transfer, or at the time a bona fide offer is made, whichever period is longer. Any resident admitted after the notification period must also be informed in writing of the Licensee’s intent to sell or transfer the facility prior to signing an admission agreement. The Licensee is also required to ensure that a copy of the written notice is sent to the licensing agency.

An interview with Resident1 (R1) confirmed that they had no knowledge of the Licensee and believed the ADM was the owner (Licensee) of the facility. An interview with the ADM disclosed no knowledge of the Licensee providing any notification to staff, residents, or their RPs. The ADM reported that they personally sent text message notifications to residents’ RPs stating that they were the new owner. These notifications were sent months after the CHOW application had been submitted to the Department and after the ADM’s purchase of the facility.

SUPERVISORS NAME: Jerry Romero
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20251106144027
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 05/11/2026
NARRATIVE
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On January 9, 2026, the Department emailed a request to the Licensee for copies of the required written notifications provided to each resident or their Responsible Party (RP), as mandated by state regulations. The Department did not receive a response.

A review of facility records revealed that the CHOW application submitted to the Department has not been approved to date. Therefore, the Licensee remains the legal owner and is still the responsible party for the facility.

Based on interviews and records reviews, the Department determined the above-mentioned allegations to be substantiated. A substantiated finding means that the preponderance of evidence standard was met, indicating that the allegations are valid.

An exit interview was conducted withVicky Bayani. A copy of this report, along with LIC 9099D and Appeal Rights (LIC 9058), was provided. Signature below confirms receipt of these documents.

SUPERVISORS NAME: Jerry Romero
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20251106144027
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/25/2026
Section Cited
CCR
87207
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No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility.
This requirement was not met as evidenced by:
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Adninistrator will review the regulations cited and send a letter to CCL acknowledging understanding and expressing a commitment to follow the regulation by POC date.
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Based on Staff and Outside Source interviews the Licensee statement to the Department that they lacked knowledge regarding the mandated requirements with a change of ownership was falsified.
This posed a potential personal rights risk to # of # residents in care.
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Type B
05/25/2026
Section Cited
CCR
87211(a)(1)
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(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.This requirement was not met as evidenced by:
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Adninistrator will review the regulations cited and send a letter to CCL acknowledging understanding and expressing a commitment to follow the regulation by POC date.
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Based on interviews and record reviews. Based on staff interviews and record reviews, the Licensee did not report the theft of a resident’s (R1) personal belongings by Staff 1 (S1) to the Department
This posed a potential personal rights risk to # of # 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.
SUPERVISORS NAME: Jerry Romero
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5