374601190-10-16-2023-18-AS-JSRS-CWNSPK-20231016140316

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374601190
Report Date: 10/16/2023
Date Signed: 10/16/2023 02:03:21 PM

Document Has Been Signed on 10/16/2023 02:03 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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	REAL GUEST HOME OF NORTH COUNTY		FACILITY NUMBER:	374601190
ADMINISTRATOR:	AIMEE CABILING		FACILITY TYPE:	735
ADDRESS:	1225 E. PENNSYLVANIA AVENUE		TELEPHONE:	(760) 291-1349
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92027
CAPACITY: 49		CENSUS: 16	DATE:	10/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Aimee Cabiling, Administrator/Licensee		TIME COMPLETED:	02:05 PM

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Licensing Program Analyst (LPA) Jacqueline Shaw Ross conducted an unannounced annual visit. LPA met with Administrator/Licensee Aimee Cabiling at the front entrance and was granted entry. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. Facility is licensed for forty-nine (49) mentally disabled ambulatory clients; ages 18-59. The facility is three (3) floors with twenty-eight (28) bedrooms and fourteen (14) bathrooms.

Tour included:
Physical Plant: front entrance, interior and surrounding exterior. Upon entrance into the lobby area LPA observed the following:

Excessive furniture and boxed items. Administrator stated she was storing some of her personal furniture and boxed items temporarily in the lobby with plans to remove within the next few weeks. LPA issued a Technical Advisory to remove excessive furniture to reduce pathway obstruction.

Upon inspection of the outside patio area, LPA observed the following:

One discarded twin mattress leaning against the walkway rail outside. Administrator stated she was in the process of having it removed today. A Technical Advisory was issued to ensure it is removed.

Facility temperature on all floors read at 75 degrees. Clients’ main restroom water temperature on floor 2nd and 3rd tested between 118.4 and 119.8 degrees. A random sampling of clients' bedrooms were inspected and found to have furniture in good repair with sufficient lighting and mattress pads. All smoke and carbon monoxide detectors were in working order on all floors during the visit. All cleaning solutions were locked in a secure area. Facility does not house firearms and/or ammunition on grounds.

Food Services: 7 day non-perishable and 2 day of perishable food supply was observed. LPA observed the following in regards to food storage:

LPA observed excessive perishable foods stored in a locked kitchen area that appeared to be stored in an unorganized manner. LPA advised Administrator to de-clutter kitchen area and to re-organize food on shelves. A Technical Advisor was issued.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023

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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: REAL GUEST HOME OF NORTH COUNTY	FACILITY NUMBER: 374601190
	VISIT DATE: 10/16/2023

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Items reviewed/discussed: Staff present have a criminal record clearance in file and are properly associated to the facility. All required postings were posted along the facility’s wall near the front entrance of the facility. Random clients' records were reviewed and contained required and current documents. Facility and staff files were also reviewed and found to be complete. Administrator's certificate expired 6/22/2023 and was verified as having been paid. Facility dues were recently paid on 10/15/2023. Clients’ medications were inspected and appear to be dispensed according to the physicians’ orders.

No deficiencies were cited at this time however Technical Advisories were discussed with Administrator. An exit interview was conducted, Appeal’s Rights along with a copy of this report was provided to Administrator, Aimee Cabiling and her signature on this form confirms receipt of these rights.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023

LIC809 (FAS) - (06/04)

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