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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004772
Report Date: 12/03/2021
Date Signed: 12/03/2021 10:25:11 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:RDB GUEST HOMEFACILITY NUMBER:
306004772
ADMINISTRATOR:REGIE D. BANGGALATFACILITY TYPE:
740
ADDRESS:612 BRONWYN DRIVETELEPHONE:
(714) 827-5538
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 6DATE:
12/03/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Dominador Laguardia, caregiverTIME COMPLETED:
10:40 AM
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This unannounced case management visit is being conducted by Licensing Program Analyst (LPA) Kathrina Chin to follow up that the licensee was served a Notice of Termination of Tenancy. LPA Chin met with Dominador Laguardia, caregiver. LPA requested to speak with Regie Banggalat, Licensee/Administrator and Mr. Dominador stated that she is in the Philippines. Mr. Laguardia called her in Messenger and LPA spoke to Regie Banggalat on the telephone twice and she said that she is returning back on Sunday, December 5, 2021.

LPA informed her that CCLD has received information that the she has received a Notice of Termination of Tenancy within 60 days starting October 20, 2021. The 60 days time frame will be on December 19, 2021 in which the residents will need to be relocated. LPA asked as to what her plan and where will she relocate her six residents. She said that she has rented a house starting December 1, 2021 but she has not submitted the necessary paper work for the change of location because she is waiting for the blueprints of the house. Ms. Banggalat said that she will contact LPA Chin upon her return.

No deficiency cited this review as per Title 22, Division 6 of the California Code of Regulations.

An exit interview was conducted, and a copy of the report was given to Dominador Laguardia, caregiver.

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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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