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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601190
Report Date: 07/21/2022
Date Signed: 07/21/2022 02:32:23 PM

Document Has Been Signed on 07/21/2022 02:32 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:
07/21/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Aimee Cabiling, Licensee/AdministratorTIME COMPLETED:
10:05 AM
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Licensing Program Analyst (LPA) Tricia Danielson and Licensing Program Manager (LPM) Deborah Mullen arrived unannounced to the facility to verify proof of corrections of citations issued on July 19, 2022. LPA and LPM entered the facility but were unable to locate any staff. LPA phoned Licensee/Administrator (LIC) Aimee Cabiling to notify her of the presence of Community Care Licensing (CCL) staff in the facility. LIC stated she was driving and was enroute to the facility but would arrive momentarily and did arrive shortly thereafter. LIC reported her husband was in the facility. LPA and LPM were unable to locate anyone other than clients.
During today's visit, LPA and LPM toured the facility with specific attention given to the facility's kitchen area. All doors to the kitchen were secured preventing entry to any client. The kitchen was observed to still be cluttered, odorous, disorganized, and unclean. Expired breads, cereals, milk, rotting fruits and vegetables, oat milk, and previously prepared foods in pots and pans were again observed in the kitchen area and sinks. The pile of rotting food observed on July 19, 2022 had been removed. The plan of correction (POC) for the deficiency cited on July 19, 2022 concerning food services has not been met as required. A civil penalty of $100 is assessed. Civil penalties will continue to accrue in the amount of $100 per day that this plan of correction is not met.
Although medications still remain in the kitchen area, they were secured behind locked doors and were inaccessible to clients in residency. The plan of correction for the deficiency cited on July 19, 2022 concerning health related services has been met and the deficiency is cleared. LPA provided LIC with a POC clearance letter during today's visit.

An exit interview was conducted with LIC and a copy of this report was provided along with LIC 421FC - Failure to Correct Daily Civil Penalty and Appeal Rights.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2022
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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