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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004772
Report Date: 01/27/2022
Date Signed: 01/27/2022 02:29:58 PM

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:
01/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Dominador LaguardiaTIME COMPLETED:
02:45 PM
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his 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 spoke to Regie Banggalat, Licensee/Administrator over the telephone.

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. She said that she has rented a house starting December 1, 2021.

Ms. Banggalat said that she has submitted the change of location documents and she has not received the fire clearance due to an issue with the fire place in the new facility. She said that she will relocate the residents as soon as she completes the change of location process with Sacramento.

The contractor is returning to the new location/facility on February 4, 2022 to fix the fire place. Ms. Banggalat stated that it was stated to her by the fire inspector that the fire place needs to be fixed prior to a fire clearance can be issued. Ms. Bangglat said that she will move all the clients as soon as the change of location process is complete. Ms. Bangglat said that she will contact the landlord and will ensure that she is up to date with her rent.

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: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
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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