374604048-5-16-2024-08-AS-MGCO-D5C2J8-20240516172556

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604048
Report Date: 05/16/2024
Date Signed: 05/16/2024 05:28:00 PM

Document Has Been Signed on 05/16/2024 05:28 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	BONITA GUEST HOME LLC		FACILITY NUMBER:	374604048
ADMINISTRATOR:	ALEX C CAROLINO		FACILITY TYPE:	740
ADDRESS:	5735 SUNNY VIEW DRIVE		TELEPHONE:	(619) 434-9200
CITY:	BONITA	STATE: CA	ZIP CODE:	91902
CAPACITY:	6	CENSUS: 6	DATE:	05/16/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Administrator, Josefa Carolino		TIME COMPLETED:	05:20 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 1-Year Visit. LPA was greeted by, Caregiver, Maria Cerezo to whom she identified herself and discussed the purpose of the visit. All staff present have a current criminal record clearance. Administrator, Josefa Carolino arrived at the facility during the visit. According to the facility’s license, the facility has a maximum capacity of six (6) residents 60 and above of which six (6) may be non-ambulatory and one (1) may be bedridden. During today’s inspection, there were a total of six (6) residents in care. The facility is approved for two (2) hospice waivers. Currently, there are two (2) residents under hospice care and one (1) is bedridden. LPA, accompanied by caregiver, Cerezo, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Residents’ bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens, hygiene supplies, and Personal Protective Equipment were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. LPA conducted interviews with five (5) residents in care, one resident was out in the community and arrived during the visit. LPA observed residents dressed appropriately with no signs of neglect. Per interviews, no concerns were identified. (Continue LIC809C)

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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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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: BONITA GUEST HOME LLC	FACILITY NUMBER: 374604048
	VISIT DATE: 05/16/2024

NARRATIVE

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(Continue from LIC 809)

There were at least 2 days of perishable food, and at least 7 days of non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Medications were organized, labeled, as required and secured in a locked designated area.

The facility’s pool is currently emptied and secured. The licensee is currently working with a contractor and obtaining financing to demolish the pool. There were no other pools of water on the premises. Per staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Three (3) fire extinguishers were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. The room temperature in the facility was comfortable at 70 degrees. Facility staff conducted an emergency drill in March 2024, per staff emergency drills were conducted every quarter.

LPA interviewed staff and reviewed multiple staff and resident records/files. LPA interviews did not raise any licensing concerns. The files that LPA reviewed contained the required documents. Confidential records were stored in locked areas. All staff had current First Aid/CPR certificates.

During today’s visit, LPA observed via measurement with a thermometer device, that hot water temperature at taps accessible to clients complied with regulations. Water from the kitchen sink reached 118.2 F.

No violations were observed during today’s visit.

An exit interview was conducted with Administrator, Josefa Carolino, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC809 (FAS) - (06/04)

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