374603881-10-9-2025-08-AS-MGCO-DMANXA-20251009105049

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603881
Report Date: 10/08/2025
Date Signed: 10/09/2025 10:52:28 AM

Document Has Been Signed on 10/09/2025 10:52 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	MAHALO HOUSE		FACILITY NUMBER:	374603881
ADMINISTRATOR/ DIRECTOR:	GARCIA, LAURA		FACILITY TYPE:	735
ADDRESS:	805 GIVENS STREET		TELEPHONE:	(619) 869-3188
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92154
CAPACITY: 4		CENSUS: 4	DATE:	10/08/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:45 PM
MET WITH:	Administrator, Sophia Tirado		TIME VISIT/ INSPECTION COMPLETED:	04:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA identified herself and was granted entry by Caregiver Estefani Garcia. Administrator Sophia Tirado arrived during the inspection, and LPA explained the purpose of the visit. All staff present had current criminal record clearances. According to the facility license, the facility has a maximum capacity of four (4) clients, of which two (2) may be non-ambulatory. During today’s inspection, there were four (4) clients in care, including three (3) non-ambulatory clients. Per staff interviews and records review, three clients are considered non-ambulatory. One client’s physician’s report indicated ambulatory status; however, based on staff interviews and LPA observations, the client uses a wheelchair and requires assistance with transfers. LPA, accompanied by Caregiver Garcia, toured the interior and exterior of the facility. The facility was clean, safe, and in good repair. Pathways were free of obstructions and slip hazards. Client bedrooms contained required furnishings. Doors, toilets, and showers were in working order. Extra linens and hygiene supplies were available. The facility had sufficient space and equipment for dining, laundry, visitation, meetings, and client activities. The facility’s internal temperature and refrigerator/freezer temperatures were within the regulatory range. During the visit, LPA measured the hot water temperature at 106°F, which is within the required range. The facility maintained at least two days of perishable food and seven days of non-perishable food, all properly stored. (continue at LIC809C)

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Marisela Garcia-Centeno
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/08/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: MAHALO HOUSE	FACILITY NUMBER: 374603881
	VISIT DATE: 10/08/2025

NARRATIVE

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(continue from LIC809)

Groceries were delivered during the visit, ensuring an adequate food supply. Cooking and dining equipment were present. No sharp objects or toxic substances were accessible to clients. Medications were properly labeled and stored in locked areas. Confidential records were appropriately secured. No pools or other bodies of water were observed on the premises.

Per the Administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and the facility telephone were operational. The fire extinguisher was last serviced on 01/23/2025. The first aid kit was complete and accessible. Required licensing postings were observed in visible areas.

LPA interviewed staff and reviewed both staff and client records. Clients appeared well cared for, engaged in activities with staff, and were observed free from neglect. Staff interviews did not raise any licensing concerns. Client files reviewed contained all required documents. Staff records included current First Aid/CPR certifications, with the most recent training completed on 07/22/2024. The Administrator provided proof of current business liability insurance (expires 08/08/2026) and a current surety bond (expires 02/12/2027).

During the inspection, it was determined that the facility exceeded the approved capacity for non-ambulatory clients. One (1) deficiency was cited in accordance with California Code of Regulations, Title 22. Refer to the attached LIC 809-D for details. A Plan of Correction (POC) was developed jointly with the Administrator, Sophia Tirado.

An exit interview was conducted with Administrator Sophia Tirado, who received copies of this report and the Licensee/Appeal Rights (LIC 9058 03/22).

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Marisela Garcia-Centeno
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/08/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/09/2025 10:52 AM - It Cannot Be Edited

Created By: Marisela Garcia-Centeno On 10/08/2025 at 05:24 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: MAHALO HOUSE	FACILITY NUMBER: 374603881
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80020(b)(2)

The applicant shall notify the licensing agency if the facility plans to admit any of the following categories of clients so that an appropriate frire clearance, approved by the ciaty of county, fire department, the district providing fire protection services, or the State Fire Marshal, can be obtained prior to the acceptance of such clients: Persons who are nonambulatory, as defined in Section 80001n.(1) This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and staff interviews and record review, the licensee did not comply with the section cited above in one (1) out of four (4) clients in care, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/09/2025
	Plan of Correction
1 2 3 4	Licensee agreed to submit an application for increase in capacity for non-ambulatory status by POC date of 10/9/2025, or relocate one non-ambulatory client to a facility that meets their needs. In addition, administrator agreed to conduct appropriate training with all staff to ensure compliance with fire clearance regulations and client medical records .

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:

	Marisela Garcia-Centeno
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/08/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

LIC809 (FAS) - (06/04)

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