370802865-1-26-2024-08-AS-AROS-CZUT8C-20240126133007

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 370802865
Report Date: 01/26/2024
Date Signed: 01/26/2024 01:30:14 PM

Document Has Been Signed on 01/26/2024 01:30 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:	ORLANDO GUEST HOME		FACILITY NUMBER:	370802865
ADMINISTRATOR:	CYRALYNN MABALOT		FACILITY TYPE:	735
ADDRESS:	297 -299 ORLANDO		TELEPHONE:	(619) 444-9411
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY: 34		CENSUS: 33	DATE:	01/26/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Cyralynn Manalot		TIME COMPLETED:	01:40 PM

NARRATIVE
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	Licensing Program Analyst (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection. LPA Rodgers was granted entry into the facility by Administrator Director Cyralynn Mabalot, after identifying herself and stating the purpose of the inspection. The facility serves thirty-four mentally disabled adults. This is a multi-unit complex with a single-story building in front and a two story building in back. No water features or secured perimeter. LPA was accompanied by Administrator Manalot, during a tour of the facility, which was conducted inside and out and included a sample of resident units, the dining area, recreation rooms, and food storage areas. There is a fire system in place and the carbon monoxide detectors were operational. The last disaster drill was conducted on August 2023. Exterior and interior passageways were free from obstructions. According to Administrator Mabalot there are no weapons and/or ammunition stored on the premises. Client’s room temperatures were within a comfortable range. Each resident had clean and sufficient bed linens, towels, and washcloths. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars, and non-skid mats were present in clients’ showers. Hot water temperature in residents’ bathrooms were compliant. [Continued on 809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

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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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: ORLANDO GUEST HOME	FACILITY NUMBER: 370802865
	VISIT DATE: 01/26/2024

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[Continued on 809]

Facility has a two-day supply of perishable and a seven-day supply of nonperishable food items. Food supply is replenished frequently by outside vendors as well as personal shopping. Food was observed to be properly stored and labeled. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked closet. The medication area is in the kitchen, not accessible to clients. Medication carts are locked in a designated area in the kitchen. Medications were labeled and kept in compliance with label instructions.

LPAs interviewed multiple staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained all required documents. LPA Rodgers also conducted a review of In-service training procedures. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance as surety bond insurance. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs.

No deficiencies were observed or cited; however, technical violation was issued.

An exit interview was conducted and a copy of this report, Licensee/Appeal Rights - LIC 9058 (rev. 01/16), and the LIC9102 was provided to the Administrator Mabalot, whose signature on this form acknowledges receipt of these documents.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

LIC809 (FAS) - (06/04)

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