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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600798
Report Date: 12/18/2024
Date Signed: 12/18/2024 05:59:47 PM

Document Has Been Signed on 12/18/2024 05:59 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:LYN'S HOME CARE IFACILITY NUMBER:
374600798
ADMINISTRATOR/
DIRECTOR:		ABILLE, LYDIAFACILITY TYPE:
735
ADDRESS:1398-B 4TH AVENUETELEPHONE:
(619) 422-1181
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 6CENSUS: 6DATE:
12/18/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Caregiver Rudyard “Rudy” Abille and Licensee Lydia AbileTIME VISIT/
INSPECTION COMPLETED:
06:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to cite a deficiency identified during a separate complaint investigation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Rudyard “Rudy” Abille. LPA also spoke with Licensee Lydia Abile via phone during today’s visit.

During today’s facility tour, LPA observed: 1) a three-dimensional layer of dust on facility window blinds on the first floor/story, 2) a three-dimensional layer of dust on the second-floor railing and railing baseboard, and 3) a large collection of trash/refuse in the facility’s back yard and side yard. LPA personally walked with Licensee’s staff and E-mailed photos to Licensee, to ensure shared understanding/clarity about the areas of facility uncleanliness.

One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). A Plan of Correction was jointly developed with the Licensee.

An exit interview was conducted with Rudyard Abille and Lydia Abille, to whom a copy of this report, the LIC 809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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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Document Has Been Signed on 12/18/2024 05:59 PM - It Cannot Be Edited


Created By: Dang Nguyen On 12/18/2024 at 05:47 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LYN'S HOME CARE I
FACILITY NUMBER: 374600798

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2025
Section Cited
CCR
80087(a)

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80087 Buildings and Grounds: “(a) The facility shall be clean [and] sanitary…at all times for the safety and well-being of clients, employees and visitors.” This requirement was not met, as evidenced by:
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Licensee agreed to remove the refuse from the back and side yards, and to clean the referenced areas to ensure they are free of dust. Licensee agreed to send to LPA photographs of the areas after they are cleaned, by the POC due date.
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Based on observation, Licensee did not ensure the facility was clean and sanitary at all times for the well-being of clients, employees, and visitors. This posed a potential health and person rights risk to 6 of 6 clients (C1 through C6) 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.
SUPERVISOR'S NAME:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2024


LIC809 (FAS) - (06/04)
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