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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602877
Report Date: 09/24/2024
Date Signed: 09/24/2024 01:55:58 PM


Document Has Been Signed on 09/24/2024 01:55 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, 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: 1DATE:
09/24/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensees Eric Castillo and Rowena CastilloTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analysts (LPA) Dang Nguyen and Juliana Barfield conducted an unannounced Legal / Non-Compliance Case Management visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Licensees Eric Castillo and Rowena Castillo.

On 09/20/2024, the CCLD San Diego Regional Office met with the Licensees for a Non-Compliance Conference (NCC). As per the terms of the NCC meeting, the facility is under increased monitoring by CCLD.

During today’s visit, LPAs conducted a general tour of the facility and performed a welfare check on the one (1) resident in care. LPAs interviewed the resident, pertinent facility staff, and outside sources. LPAs also obtained copies of and reviewed resident care records.

Care records and interviews of staff and outside sources unanimously showed that Resident #1 (R1) moved in to the facility on 08/05/2021, and that at time of move-in, R1 relied on a walker mobility device. [See LIC811 Confidential Names List for a description of R1.]

Outside source interviews showed R1 continued to rely on their walker, through the present time. During today’s visit, LPAs observed R1 rely on their walker while ambulating. Although R1 was diagnosed with Dementia and could not remember past events, they said of their walker device, “I can’t walk without it.”

Although R1’s LIC602 Physician’s Report (dated 08-08-2021) listed them as Ambulatory, according to California Code of Regulations (CCR), Title 22, Section 87101 Definitions, residents who use “mechanical aids such as crutches, walkers, and wheelchairs” are considered Nonambulatory persons.

[CONTINUED ON LIC 809-C]
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: GOLDEN CARE FACILITY
FACILITY NUMBER: 374602877
VISIT DATE: 09/24/2024
NARRATIVE
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[CONTINUED FROM LIC 809]

According to the facility’s License from CCLD and its prior-approved Fire Clearance: The facility is only licensed to care for up to six (6) residents, of whom all must be Ambulatory. A preponderance of evidence exists to show that Licensee operated the facility beyond the conditions and limitations specified on its License and Fire Clearance.

One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). Since the deficiency represents a violation of the facility’s fire clearance, an Immediate Civil Penalty of $500 was also assessed (see the LIC 421-IM page). A Plan of Correction was jointly developed with the Licensee.

An exit interview was conducted with Eric Castillo and Rowena Castillo, to whom a copy of this report, the LIC 809-D, the LIC421-IM, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/24/2024 01:55 PM - 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: GOLDEN CARE FACILITY
FACILITY NUMBER: 374602877

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/24/2024
Section Cited
CCR
87204(a)

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87204 Limitations – Capacity and Ambulatory Status: “(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license…” This requirement was not met, as evidenced by:
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As of the date of deficiency issuance, Licensee had completed a written reappraisal of R1’s care needs and had issued written eviction notice to R1 and their responsible person (as the facility is in the process of closing). Licensee also coordinated with R1’s responsible person to arrange for R1 to see their primary physician this week to complete an updated LIC602 Medical Assessment. These actions resolve the immediate risk. Licensee agreed to E-mail LPA Nguyen a copy of the updated LIC602, as soon as it is received, but no later 10-24-2024.
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Based on records and interviews, the Licensee operated the facility beyond the conditions and limitations specified on the license. This posed an immediate health and safety risk to 1 of 1 residents (R1) 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: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024
LIC809 (FAS) - (06/04)
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