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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601190
Report Date: 01/06/2023
Date Signed: 01/06/2023 12:14:58 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/18/2022 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220718134518
FACILITY NAME:REAL GUEST HOME OF NORTH COUNTYFACILITY NUMBER:
374601190
ADMINISTRATOR:AIMEE CABILINGFACILITY TYPE:
735
ADDRESS:1225 E. PENNSYLVANIA AVENUETELEPHONE:
(760) 291-1349
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY:49CENSUS: 16DATE:
01/06/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Aimee Cabaling, Licensee/AdministratorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Unlawful eviction
Facility staff speaks inappropriately towards resident
Facility staff did not accord privacy to residents in care
Facility is not taking measures to prevent bed bug investation
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Tricia Danielson arrived unannounced to the facility to conclude an investigation into the allegations listed above. LPA met with Licensee/Administrator(LIC/AD) Aimee Cabiling and explained the purpose of the visit.
Regarding the allegation "Unlawful eviction", it was alleged that Resident #1(R1) was given an eviction notice for non-compliance of house rules and incompatibility with other residents, but was not provided supporting facts of these concerns. Record review indicated R1 was provided with a written eviction notice on June 23, 2022 which did not contain specific required facts including dates, places, witnesses, and circumstances related to non-compliance of house rules nor was there any modification to R1's Needs and Services Plan conducted to indicate any incompatibility concerns or a determination that R1's needs could not be met by the facility. Interview with LIC/AD Cabiling revealed there was no supporting information for the reasons of eviction provided to R1.
Regarding the allegation "Facility staff speaks inappropriately towards resident", it was alleged that LIC/AD Cabiling screamed at and spoke inappropriately to R1. LPA interviewed twelve(12) residents. Seven(7) of twelve(12) residents interviewed indicated LIC/AD Cabiling did scream at R1 at times in addition to speaking inappropriately to or about R1 to others.(CONTINUED ON LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 18-AS-20220718134518
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: REAL GUEST HOME OF NORTH COUNTY
FACILITY NUMBER: 374601190
VISIT DATE: 01/06/2023
NARRATIVE
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(CONTINUED FROM LIC9099)
Regarding the allegation "Facility staff did not accord privacy to residents in care", it was alleged that LIC/AD Cabiling questioned residents regarding the whereabouts of R1 when R1 was not in the facility and if they knew when R1 would be returning to the facility. LPA interviewed twelve(12) residents. Seven(7) of twelve(12) residents interviewed indicated LIC/AD Cabiling did question residents about where R1 would go when they left the facility as well as R1's estimated return time.
Regarding the allegation "Facility is not taking measures to prevent bed bug infestation", it was alleged that the facility is infested with bed bugs and the Administrator has not done anything to treat the issue. LPA observed heavily bed bug infested areas on the 2nd and 3rd floors of the facility, including resident bathrooms, resident bedrooms, and the main hallways. Interview with LIC/AD Cabiling revealed the facility has not received and was not currently receiving treatment for the extermination of bed bugs.

Based on LPA’s observations, interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099 D.

An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names List and Appeal Rights.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20220718134518
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: REAL GUEST HOME OF NORTH COUNTY
FACILITY NUMBER: 374601190
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2023
Section Cited
CCR
85068.5(c)
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Eviction Procedures- (c) The licensee shall set forth in the notice to quit the reasons for the eviction, with specific facts including the date, place, witnesses, and circumstances. This requirement was not met as evidenced by: The licensee did not provide R1 with specific facts related to the reasons for eviction. Based on record review, R1's eviction
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Licensee to submitted written statement of understanding of the regulaion cited and the importance of providing a lawful eviction notice. Proof of POC to be submitted by 1/13/2023.
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notice lacked informative dates, places, witnesses, and/or circumstances related to alleged violations of the house rules.
Interview with licensee indicated this supporting information was not provided to R1 in the eviction notice. This poses a potential health, safety, and personal rights risk to residents in care.
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Type B
01/03/2023
Section Cited
CCR
80072(a)(3)
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Personal Rights- (a)...each client shall have personal rights which include...the following:(3)To be free from...unusual punishment, infliction of...humiliation,intimidation,ridicule...
mental abuse, or other actions of a punitive nature,...not limited to: interference with the daily living... functioning. This requirement was not met as evidenced by:
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Licensee agrees to submit a written statement of understanding of the regulation cited and the importance of maintaining resident's personal rights. Proof of POC to be submitted by 1/13/2023.
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The licensee did not ensure R1's personal rights were maintained. Based on interviews conducted, 7 of 12 residents indicated the licensee did scream at and speak inappropriately to and about R1. This poses a potential health, safety, and personal rights risk to residents 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.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 18-AS-20220718134518
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: REAL GUEST HOME OF NORTH COUNTY
FACILITY NUMBER: 374601190
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2023
Section Cited
CCR
80072(a)(1)
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Personal Rights- (a)...each client shall have personal rights which include, but are not limited to, the following:(1)To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by:
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Licensee agrees to submit a written statement of understanding of the regulation cited and the importance of maintaining resident's personal rights. Proof of POC to be submitted by 1/13/2023.
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The licensee did not maintain R1's personal rights. Based on interviews conducted, 7 of 12 residents indicated the licensee did question residents where R1 goes when away from the facility and what time R1 would return to the facility. This poses a potential health, safety, and personal rights risks to residents in care.
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Type B
01/03/2023
Section Cited
CCR
80087(a)(1)
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Buildings and Grounds- (a)The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1) The licensee shall take measures to keep the facility free of flies and other insects. This requirement was not met as evidenced by:
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Licensee to submit written plan of planned treatment of bed bugs and proof of signed contract with extermination company indicating treatment of bed bugs. Proof of POC to be submitted by 1/20/2023.
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The licensee did not take measures to keep the facility free of insects. Based on LPA observation and interview with licensee, the facility's 2nd and 3rd floors are infested with bed bugs and licensee revealed the facility was not being treated for bed bugs. This poses a potential health, safety, and personal rights risk to residents 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.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5