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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602877
Report Date: 08/05/2022
Date Signed: 08/08/2022 08:57:54 AM


Document Has Been Signed on 08/08/2022 08:57 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:GOLDEN CARE FACILITYFACILITY NUMBER:
374602877
ADMINISTRATOR:ERIC CASTILLOFACILITY TYPE:
740
ADDRESS:2239 CRANDALL DRIVETELEPHONE:
(858) 560-6497
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:6CENSUS: 3DATE:
08/05/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:46 PM
MET WITH:Licensee, Eric CastilloTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Daniel Pena conducted a case management visit to cite for deficiencies observed during an unannounced 1-year Required inspection visit on 8/5/22. LPA was greeted by, introduced himself to, and explained the purpose of the visit to Licensee, Eric Castillo.

On 8/5/22, LPA requested criminal background clearance records for Staff 1 (LIC811 Confidential Names List provided to Licensee, Castillo to identify S1). Per a review of facility records, S1’s name was not listed on the Community Care Licensing Division’s Facility Personnel Report Summary. Information obtained from the Licensee during the visit, it was revealed that S1 was only going to provide care/supervision for a couple hours.

Licensee informed LPA that S1 had not received background clearance which is confirmed by facility records. LPA advised Licensee, Castillo that S1 is not allowed to work or reside at the facility until they have completed a fingerprint clearance. Licensee acknowledged LPA’s direction and removed S1 from facility during the visit to have them fingerprinted.

The following deficiencies and civil penalties have been cited per Title 22, Division 6 of the California Code of Regulations (See LIC 809D and LIC 421BG).
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
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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Document Has Been Signed on 08/08/2022 08:57 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: GOLDEN CARE FACILITY
FACILITY NUMBER: 374602877

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/05/2022
Section Cited

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Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by:
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Based on observation and facility records, Licensee did not ensure S1 received a criminal record clearance or exemption prior to working at the facility. 1 out of 3 staff did not have a criminal record clearance. This poses an immediate health and safety 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: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2022
LIC809 (FAS) - (06/04)
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