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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602991
Report Date: 02/21/2024
Date Signed: 02/21/2024 12:08:28 PM


Document Has Been Signed on 02/21/2024 12:08 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:VERDUGO BOARDING HOMEFACILITY NUMBER:
374602991
ADMINISTRATOR:JACOME, RIGOBERTO GARCIAFACILITY TYPE:
740
ADDRESS:690 HELEN DRIVETELEPHONE:
(760) 757-8403
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:6CENSUS: 4DATE:
02/21/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Licensee Rigoberto GarciaTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted a plan of correction visit. LPA was greeted by, identified herself to, and explained the purpose of the visit to Licensee Rigoberto Garcia.

The purpose of the visit was to verify if the deficiency 87506(d) issued on 1/26/2024 regarding the Department's authority to review resident records had been corrected. On 1/26/2024, the licensee was issued a deficiency with a correction due date of 2/9/2024.

During today’s visit, LPA Ruiz was unable to verify that the licensee corrected the deficiency regarding the Department's authority to review resident records prior to today's visit. The Licensee confirmed that he had not submitted a written letter stating that he had read and understood regulation 87506. Therefore, the deficiency 87506(d) has not been corrected by the POC due date. An immediate civil penalty of $100 per day for a total of $1,200 has been assessed on an LIC421FC for failure to correct. LPA provided guidance regarding appeal rights for civil penalties.
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During today's visit, LPA Ruiz granted Licensee a POC extension for deficiency 87705(c)(5) with a new POC due date of 3/8/2024 on an LIC178. LPA Ruiz also observed Licensee review regulation 87506 and Licensee provided LPA with a written letter confirming that the Licensee read and understood regulation 87506. Therefore, the deficiency is cleared.

An exit interview was conducted with Licensee Rigoberto Garcia. Licensee Rigoberto Garcia refused to sign the LIC421FC and the LIC809. LPA Ruiz provided Licensee Rigoberto Garcia with hard copies of this report (LIC809), the LIC178, the LIC421FC, and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024
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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