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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603413
Report Date: 02/20/2024
Date Signed: 02/20/2024 12:35:58 PM


Document Has Been Signed on 02/20/2024 12:35 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:CASA VERDUGOFACILITY NUMBER:
374603413
ADMINISTRATOR:OZORIO-VERDUGO, NATALIAFACILITY TYPE:
740
ADDRESS:5164 E PARKER STTELEPHONE:
(760) 754-2504
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:6CENSUS: 3DATE:
02/20/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Caregiver Araceli RamirezTIME COMPLETED:
12:40 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 Caregiver Araceli Ramirez. Licensee Natalia Verdugo arrived during the visit.

The purpose of the visit was to verify if the two deficiencies regarding resident and staff files issued on 1/19/2024 had been corrected by the correction due date of 2/16/2024.

During today’s visit, LPA Ruiz spoke with Licensee Natalia and Caregiver Carolina Garcia regarding the POC documentation and reviewed resident and staff records. Resident and staff records were not complete and the Licensee confirmed that the records present at the facility had not been updated. An immediate civil penalty of $100 per day totalling $400 for 2/17/2024 to 2/20/2024 is being assessed on an LIC421FC for failure to correct the resident records by POC due date. The Licensee completed the required paperwork for resident records during the visit, which LPA verified. Therefore, the deficiency 87506(a) regarding resident files has been corrected as of 2/20/2024 and LPA provided Licensee with a letter of Deficiency Cleared.

Staff records were not complete and the Licensee stated that the delay was due to waiting on availability for doctor appointments. Licensee requested a POC due date extension, which LPA granted until 3/19/2024. LPA provided Licensee with technical assistance regarding requesting POC due date extensions.

An exit interview was conducted with Licensee Natalia Verdugo, whose signature below confirms receipt of a copy of this report, the LIC421FC, LIC178, LIC9102TA, LIC811, Letter of Deficiency Cleared, 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: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2024
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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