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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601190
Report Date: 08/05/2022
Date Signed: 08/05/2022 01:27:51 PM

Document Has Been Signed on 08/05/2022 01:27 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: 16DATE:
08/05/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Aimee Cabiling, Licensee/AdministratorTIME COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Tricia Danielson and Regional Manager (RM) Reyna Lacey made an unannounced POC visit to the facility to verify correction of citations issued during a case management visits conducted on 7/19/2022 and 7/21/2022 . Based upon this inspection, the LPA and RM observed the following:
The following deficiencies were previously received and corrected by the POC due date:
Deficiencies cited under Title 22 Regulation 80088(f)(1) Furniture, Fixtures, Equipment and Supplies, 80087(a) Buildings and Grounds, 80087(g) Buildings and Grounds, 80075(l) Health Related Services, have been cleared.

The following deficiencies were not corrected by the POC due date but were cleared during today's visit:
Deficiency cited under Title 22 Regulation 80076(a)(1) Food Services, has been cleared during today's visit. LPA observed rotting fruits and expired pastries during today’s visit but these items were discarded prior to CCL staff's departure. POC due date for this was 7/22/2022.

The following deficiencies were not corrected by the POC due date nor at the time of this visit. Civil penalties are being assessed and will continue to accrue until correction has been submitted:



Deficiency cited under Title 22 Regulation 80087(a)(1) Buildings and Grounds has not been cleared. POC due date for this was 7/22/2022. Proof of POC was not submitted by due date and bed bugs remain in Room 306 and 3rd floor hallway as observed during today's visit. Civil penalties assessed today at $100.00 per day per citation. Today's civil penalty assessment of $300.00 is for the period of 8/2/2022 through 8/4/2022.

Deficiency cited under Title 22 Regulation 80075(k)(5) Health Related Services has not been cleared. POC
(CONTINUED ON LIC 809C)
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/05/2022
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(CONTINUED FROM LIC 809)
due date for this was 7/22/2022. Proof of POC was not submitted by the due date and loose pills were observed in the med room and food prep area during today's visit. Civil penalties assessed today at the rate of $100.00 per day per citation. Today's civil penalty assessment of $1,300.00 is for the period of 7/23/2022 through 8/4/2022.
Civil Penalties assessed today total $1600. An exit interview was conducted and a copy of this report was provided to Licensee along with POC clearance letters, civil penalties, and appeal rights.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
LIC809 (FAS) - (06/04)
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