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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604232
Report Date: 02/05/2025
Date Signed: 02/05/2025 05:15:46 PM

Document Has Been Signed on 02/05/2025 05:15 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:REMINGTON CLUB IIFACILITY NUMBER:
374604232
ADMINISTRATOR/
DIRECTOR:		TERRI BOSTIANFACILITY TYPE:
740
ADDRESS:16922 HIERBA DRIVETELEPHONE:
(858) 673-6333
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY: 140TOTAL ENROLLED CHILDREN: 0CENSUS: 51DATE:
02/05/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Raquel Mathews, Director of Health and WellnessTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carmen Lopez conducted a complaint investigation and in conjunction conducted this unannounced required annual continuation visit to complete the annual inspection started on January 23, 2025. LPA Lopez identified herself, was granted entry by concierge Sabrina Uchino. LPA discussed the purpose of the visit with Director of Health and Wellness, Raquel Mathews. Megan Milligan, Business Office Manager later arrived and joined the visit

During today's visit, LPA finalized the review of resident records and reviewed staff records. Due to time constraints, the inspection could not be completed, and a subsequent visit will be conducted at a later date to complete the required annual inspection.

There were deficiencies observed and cited during today’s visit and can be reviewed on the LIC809-D page of this report.

An exit interview was conducted with Director of Health and Wellness Raquel Mathews, and Megan Milligan, Business Office Manager to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received.
Robyn ClarkTELEPHONE: (619) 767-2312
Carmen LopezTELEPHONE: (619) 767-2301
DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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 02/05/2025 05:15 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: REMINGTON CLUB II
FACILITY NUMBER: 374604232

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2025
Section Cited
CCR
87412(g)(1)

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Personnel Records 87412 (g)(1) The licensee shall be permitted to retain such records in a central administrative location provided that they are readily available to the licensing agency at the facility as specified in Section 87412(f). This requirement was not met as evidence by:
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Facility will obtain records and place them in the staff file for S1 and send a copy to LPA by POC due date, 02/28/2025.
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Based on records review the facility did not comply with the section cited above in one out of the five staff records were not readily available with complete documents, which posed a potential personal rights risk to persons in care.
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Type B
02/28/2025
Section Cited
CCR87506(b)(16)

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Resident Records 87506 (b)(16) Records of resident's cash resources as specified in Section 87217, Safeguards for Resident Cash, Personal Property, and Valuables. This requirement was not met as evidence by:
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Facility will send a completed copy of the SPV forms for the following residents: R2, R5, R6 and R7 and submit to LPA once they are completed by POC due date, 02/28/2025.
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Based on records review the facility did not comply with the section cited above in four out of the ten residents did not have a Personal Property/Valuables form on file, which posed a potential personal rights risk to persons 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.
Robyn ClarkTELEPHONE: (619) 767-2312
Carmen LopezTELEPHONE: (619) 767-2301

DATE: 02/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2025

LIC809 (FAS) - (06/04)
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