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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603456
Report Date: 10/14/2022
Date Signed: 10/14/2022 12:24:11 PM


Document Has Been Signed on 10/14/2022 12:24 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:GARDENS AT ESCONDIDOFACILITY NUMBER:
374603456
ADMINISTRATOR:HERNANDEZ, MARIANOFACILITY TYPE:
740
ADDRESS:1342 N ESCONDIDO BLVDTELEPHONE:
(760) 480-8155
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:101CENSUS: 56DATE:
10/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Assistant WExecutive Director, Ferlina McBrideTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Janira Arreola conducted a visit to the facility to conduct a prelicensing inspection and found the following deficiencies. LPA met with assistant executive director, Ferlina McBride was informed of the following:
  • The facility's current executive director, Amy Banaga was out and the assistant director's administrator's certificate was currently pending. LPA called the administrator line and was informed by the department that the certificate was still processing. The facility must have a designated person in charge that meet the administartor qualifications.
  • LPA was informed that (9) living units on the west wing of the first floor had flood damage. LPA was informed by McBride that there was no incident report on file for this incident.


These deficiencies were recorded on an LIC809-D page along with plan of corrections.

An exit interview was conducted were this report, along with 809-D page and appeal rights were reviewed and provided to Ferlina McBride.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
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 2


Document Has Been Signed on 10/14/2022 12:24 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507


FACILITY NAME: GARDENS AT ESCONDIDO
FACILITY NUMBER: 374603456

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/14/2022
Section Cited

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"(a) Each licensee shall furnish... (1) A written report shall be submitted to the licensing agency... (D) Any incident which threatens the...safety...of any resident..." This requirment was not met as evidenced by:
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Based on interview and records review, The licensee failed to inform the department of a flood at the facility. This posed a potewntial health saftey or personal rights risk.
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Type B
10/24/2022
Section Cited

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"87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator... When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications...as specified in this section..." This requirment was not met as evidenced by:
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Based on interview and records review it was found that the designated person in charge while the adminsitrator is out has a pending adminsitrator certificate. This poses a potential health saftey or personal rights 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: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2