372004250-4-12-2023-08-AS-DNGN-CQTLVJ-20230412090538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 372004250
Report Date: 04/11/2023
Date Signed: 04/12/2023 09:05:59 AM

Document Has Been Signed on 04/12/2023 09:05 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	CABANAS CARE HOME		FACILITY NUMBER:	372004250
ADMINISTRATOR:	ERNESTO CABANAS		FACILITY TYPE:	740
ADDRESS:	1303 MISSOURI STREET		TELEPHONE:	(760) 439-2262
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92054
CAPACITY:	6	CENSUS: 0	DATE:	04/11/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	05:30 PM
MET WITH:	Licensee's Representative Janet Craig		TIME COMPLETED:	06:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Dang Nguyen conducted a case management visit regarding licensee initiated facility closure. Licensee's Representative, Janet Craig, joined the visit via phone.

On 10-27-2021, Licensee Ernesto Cabanas submitted a letter to the CCLD San Diego Regional Office (RO), stating that he planned to cease operations and close the facility on 12-30-2021. However, the facility’s closure was postponed because there were still residents in care. On 03-10-2022, Licensee amended the above letter to state the facility would close on 03-18-2022, but it cannot be verified when licensee submitted the amendment to the RO.

On 02-16-2023, the RO received notification from the office of the San Diego County Long Term Care Ombudsman Program (LTCOP), stating that during an attempted visit to the facility on 01-25-2023, an Ombudsman discovered that there were no staff or residents in care, and interview of a renter/tenant who was present confirmed that the facility had prior underwent a change in use.

LPA’s subsequent attempts to reach Licensee Ernesto Cabanas were unsuccessful. On 03-01-2023, LPA made phone contact with the Licensee’s adult child and representative, Earl Cabanas, who confirmed the property ceased being a care facility prior to 03-18-2022, and that Licensee no longer had control of property. On 03-30-2023, Licensee’s other adult child and representative, Janet Craig, provided LPA with the contact information for the current renter/tenant.

[CONTINUED ON LIC 809-C]

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CABANAS CARE HOME	FACILITY NUMBER: 372004250
	VISIT DATE: 04/11/2023

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[CONTINUED FROM LIC 809]

During today's visit, LPA visited the facility's address and met with the current renter/tenant. LPA identified himself, explained the purpose of the visit, and was welcomed inside. LPA briefly toured the facility and verified that there were no residents in care. There was no resident clothing or belongings present. All licensing postings had been removed. No deficiencies were issued, and the facility is ready for closure.

An exit interview was conducted with Janet Craig, via phone. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided to both Craig and the Licensee, via their respective E-mail addresses.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC809 (FAS) - (06/04)

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