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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601190
Report Date: 07/19/2022
Date Signed: 07/19/2022 05:05:16 PM

Document Has Been Signed on 07/19/2022 05:05 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
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: 17DATE:
07/19/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Aimee Cabiling, Licensee/AdministratorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Tricia Danielson observed the following deficiencies during a visit for complaint control #18-AS-20220718134518. LPA was met at the front door by Licensee/Administrator (LIC) Aimee Cabiling.

Immediately upon entry to the facility, LPA observed two (2) grocery carts full of bagged, boxed, and canned food parked in a hallway type area to the right of the front entry area. LPA observed a swarm of flies surrounding and inside many of the bags of bread in the carts as well as inside a wrapped cauliflower. Flies were observed on the wall immediately next to the carts. Some loaves of bread where dated June 2022 and early July 2022. Some did not have dates. LPA also observed semi-frozen marinated packaged meat in one cart that was dated July 1st, 2022. LIC removed these carts prior to LPA's departure.
LPA continued a tour of the immediate area and discovered the kitchen. LPA observed the kitchen to be woefully cluttered, odorous, disorganized, and entirely unclean. LPA observed a pile of rotting food on the counter, overflowing trash bins, facial razors, rotting vegetables and fruit, innumerous shopping bags filled with other shopping bags, and piles of cookware. LPA also observed pots of cooked rice, another pot with an apparent soup/ramen type food in it, and cooked eggs. These were later verified to have been today's lunch and dinner. LPA also observed multivitamins and other over the counter vitamins such as vitamin C and Zinc sitting on the counter in addition to several resident's prescription medications. Some loose pills were observed in several single use medicine cups as well.
LIC stated the residents do not have access to the kitchen because the door as is usually locked however, LPA observed the door to be wide open and was able to walk right in unencumbered.
Therefore, based on the observations made during today’s visit, the following deficiencies were cited per Title 22, Division 6 of the California Code of Regulations. See LIC 809D. An exit interview was conducted and this reported was provided along with appeal rights.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2022
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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Document Has Been Signed on 07/19/2022 05:05 PM - It Cannot Be Edited


Created By: Tricia Danielson On 07/19/2022 at 04:18 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
, 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: 07/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/20/2022
Section Cited
CCR
80076(a)(17)

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Food Services- (a) In facilities providing meals to clients, the following shall apply:(17) All kitchen, food preparation, and storage areas shall be kept clean, free of litter and rubbish, and measures shall be taken to keep all such areas free of rodents, and other vermin. This requirement was not met as evidenced by:
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Licensee will have kitchen cleaned, decluttered and will dispose of all rotting and expired foods by POC due date.
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The Licensee did not ensure the kitchen was kept in a clean manner. Based on LPA observations, the facility kitchen was unclean, and cluttered. This poses an immediate health, safety, and personal rights risk to residents in care.
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Type A
07/20/2022
Section Cited
CCR80075(k)(1)

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Health Related Services:(k)The following requirements shall apply...(1)Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible...of the centrally stored medication. This requirement was not met as evidenced by:
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Licensee will secure all medications in a locked cabinet or room inaccessible to others by POC due date.
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The Licensee did not ensure medications were secured and inaccessible to residents. Based on LPA observation, prescription medciations were observed on the food prep area of the unlocked kitchen. This poses an immediate 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.
SUPERVISOR'S NAME:Deborah Mullen
LICENSING EVALUATOR NAME:Tricia Danielson
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2022


LIC809 (FAS) - (06/04)
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