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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604270
Report Date: 03/06/2025
Date Signed: 03/06/2025 06:43:55 PM

Document Has Been Signed on 03/06/2025 06:43 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:ALLIANCE GUEST HOMEFACILITY NUMBER:
374604270
ADMINISTRATOR/
DIRECTOR:		CHONG, CANDYFACILITY TYPE:
735
ADDRESS:1525 OLEANDER AVENUETELEPHONE:
(619) 349-3204
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 4CENSUS: 3DATE:
03/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Lead Caregiver Elizabeth De Guia and Administrator Henrietta “Candy” ChongTIME VISIT/
INSPECTION COMPLETED:
07:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Lead Caregiver Elizabeth De Guia. LPA then met with Licensee and Administrator Henrietta “Candy” Chong, who arrived later during the visit.

According to the facility’s license, the facility has a maximum capacity for four (4) clients, of whom all may be ambulatory or non-ambulatory, and one (1) may be bedridden (in Bedroom #1 only, per the facility sketch). According to LIC602 Physician’s Reports, staff interviews, and LPA observation: During this annual inspection, there were a total of three (3) clients in care [Client #1 (C1), Client #2 (C2), and Client #3 (C3)], all of whom were diagnosed with an intellectual disability. [See LIC811 Confidential Names list pages for a description of select person identifiers used in this report.] C1 was bedridden and located in Bedroom #1, as required. C2 and C3 were both ambulatory persons. The facility’s license did not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present.

During this inspection, LPA interviewed all clients and multiple staff. LPA reviewed the care records for all clients and the personnel and training files for all current staff. LPA also toured the interior and exterior of the facility and inspected all common areas and bedrooms. The facility’s ambient internal temperature was initially too cold, at 63 F. (Regulation requires a minimum temperature of 68 F in areas occupied by clients.) At the time of LPA’s thermostat check, C2 was the only client present inside the facility. (C1 and C3 arrived home from day program later during LPA’s visit). With staff permission, LPA turned the central heater on and brought the facility’s ambient temperature into the compliant range. Hot water at taps accessible to the clients were initially too hot: Kitchen Sink was 123.6 F, Bathroom #1 Sink was 126.1 F, and Bathroom #2 Sink was 125.4 F. (Regulation requires these taps to be between 105 F and 120 F). With staff permission, LPA adjusted the facility’s water heater settings, then remeasured these same taps, ensuring each was brought back within the complaint temperature range. [CONTINUED ON LIC 809-C, 1 of 2]
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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 6
Document Has Been Signed on 03/06/2025 06:43 PM - It Cannot Be Edited


Created By: Dang Nguyen On 03/06/2025 at 04:08 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: ALLIANCE GUEST HOME
FACILITY NUMBER: 374604270

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, Licnesee did not ensure that disinfectants, cleaning solutions, and other items that could pose a danger if readily available to clients were stored where inaccessible to clients. This posed an immediate health and safety risk to 2 of 3 clients (C2 and C3) in care.
POC Due Date: 03/06/2025
Plan of Correction
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During today's visit, LPA and staff immediately secured/locked all disinfectants, cleaning solutions, and other items that could post a danger to clients, resolving the immediate risk. Licensee agreed to retrain all remaining staff on this topic and on keeping staff keys on their person at all times. Licensee agreed to E-mail the training sign-in sheet to LPA by 04/06/2025.
Type A
Section Cited
CCR
80076(a)(16)
Food Service
(a) In facilities providing meals to clients, the following shall apply: (16) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA obsevation, Licensee did not ensure that a soap detergent / cleaning compound was stored in an area separate from food supplies. This posed an immediate health and safety risk to 3 of 3 clients (C1, C2, and C3) in care.
POC Due Date: 03/06/2025
Plan of Correction
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During today's visit, LPA and staff immediately relocated the bottle of laundry detergent to a different cabinet that was seperate/away from food storage, resolving the immediate risk. Licensee agreed to retrain all remaining staff on this topic, and to E-mail the training sign-in sheet to LPA by 04/06/2025.
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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 03/06/2025 06:43 PM - It Cannot Be Edited


Created By: Dang Nguyen On 03/06/2025 at 04:08 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: ALLIANCE GUEST HOME
FACILITY NUMBER: 374604270

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80088(a)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) The licensee shall maintain the temperature in rooms that clients occupy between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation and thermostat measurement, Licensee did not maintain the temperature in rooms that clients occupy to a minimum of 68 degrees F. This posed a potential health and personal rights risk to 1 of 3 clients (C2) in care.
POC Due Date: 04/06/2025
Plan of Correction
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During today's visit, LPA and staff adjusted the facility's themostat to raise the temperature to 68 F, resolving the deficiency. Licensee agreed to retrain all staff on regulatory requirements related to facility temperature, and to E-mail the training sign-in sheet to LPA by the POC due date.
Type B
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation and thermometer measurement, Licensee did not maintain hot water temperature controls such that hot water delivered to plumbing fixtures used by clients was between 105 degrees F and 120 degrees F. This posted a potential personal rights risk to 3 of 3 clients (C1, C2, and C3) in care.
POC Due Date: 04/06/2025
Plan of Correction
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During today's visit, LPA and staff adjusted the facility's water heater to bring all plumbing fixtures used by clients back into the compliant temperature range, resolving the deficiency. Licensee agreed to retrain all staff on regulatory requirements related to hot water temperature, and to E-mail the training sign-in sheet to LPA by the POC due date.
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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 03/06/2025 06:43 PM - It Cannot Be Edited


Created By: Dang Nguyen On 03/06/2025 at 04:08 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: ALLIANCE GUEST HOME
FACILITY NUMBER: 374604270

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80022(e)(4)
Plan of Operation
(e) If the licensee intends to admit or care for one or more clients who rely upon others to perform all activities of daily living, the plan of operation must also include a statement that demonstrates the licensee's ability to care for these clients. The evidence of ability may include but not be limited to: (4) Documentation of training the licensee and/or staff have completed specific to the needs of these clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and staff interviews, Licensee did ensure that staff caring for 1 of 3 clients (C1), who relied on others to perfrom all activitiesof daily living, had training specific to the needs of that client. This posed a potential health risk to persons in care.
POC Due Date: 04/06/2025
Plan of Correction
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Licensee agreed to update the Plan of Care for C1, and to then train all current staff on it. Licensee agreed to E-mail the updated Plan of Care for C1 and the training sign-in sheet to LPA, by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ALLIANCE GUEST HOME
FACILITY NUMBER: 374604270
VISIT DATE: 03/06/2025
NARRATIVE
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[CONTINUED FROM LIC 809]

LPA observed a non-locking drawer in the facility’s kitchen, which contained two (2) bottles of Clorox bleach. (Regulation requires disinfectants and cleaning solutions to be stored inaccessible to clients). LPA subsequently directed staff to relocate these chemicals to a different cabinet in the garage that was able to be locked. Inside the facility’s garage (which is accessible to clients due to the configuration of the knob/handle of the pedestrian door leading into it from the dining room) was an unlocked cabinet. When LPA opened said cabinet, he observed a bottle of laundry detergent beside a small cache of non-perishable food, on the same shelf. (Regulation requires soaps, detergents, and similar cleaning compounds to be stored in areas separate from food supplies). LPA directed staff relocate the laundry detergent to an entirely different cabinet which could be locked.

The second floor of the premises was exclusively quarters for the live-in staff, but also connected to the facility’s first floor via a flight of stairs. With staff accompanying him, LPA went to the second floor and observed that staff do not lock either the bathroom or two bedrooms there. Inside the unlocked upstairs bathroom, was an unlocked cabinet, containing five (5) bottles of cleaning chemicals (to include Drano). Inside one of the unlocked upstairs bedrooms was a staff’s prescription medication, in plain sight atop a dresser. (C1 and C3 were each deemed ambulatory by their respective physicians. LPA observation and manager interview showed that both C1 and C3 were capable of climbing stairs.) LPA subsequently directed staff to lock their second-floor bedrooms and bathroom.

The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens, hygiene supplies, and Personal Protective Equipment (PPE) were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Appliances to preserve perishable food were complaint in temperature: Kitchen Refrigerator was 39 F, and Kitchen Freezer was 0 F. There were at least (2) days of perishable food and at least seven (7) days non-perishable food present. Cooking/dining equipment and utensils were present and in good condition.


[CONTINUED ON LIC 809-C, 2 of 2]
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ALLIANCE GUEST HOME
FACILITY NUMBER: 374604270
VISIT DATE: 03/06/2025
NARRATIVE
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[CONTINUED FROM LIC 809-C, 1 of 2]

No pools or bodies of water observed on the premises. The facility's fireplace was screened. There were no open-faced heaters accessible to clients. Smoke detectors, carbon monoxide detector, emergency lighting, night lights, and facility telephone were all working. Confidential records were stored in locked areas. Required licensing postings were observed in visible areas of the facility. Per the Licensee, no firearms or ammunition were kept at the facility. Licensee presented proof of current business liability insurance and surety bond.

During review of client and personnel records, LPA observed, and manager interview confirmed: C1 was “a client who relied upon others to perform all activities of daily living.” However, Licensee did not ensure facility staff had “client-specific training” on C1’s unique care needs, as was required by regulation.

Five (5) deficiencies were cited per California Code of Regulations, Title 22 (refer to the LIC809-D pages). Plans of Correction were jointly developed with the Licensee. Since one (1) of the deficiencies is repeat violation within the last twelve (12) months, a civil penalty of $250 was assessed/charged (refer to the LIC421-IM pages). LPA issued one (1) Technical Violation (TV) regarding needing to vary the type of disaster to be drilled each quarter with staff (refer to the LIC9102-TV page). LPA also provided Technical Assistance (TA) regarding refresher training for staff on California Mandated Reporting requirements (refer to the LIC9102-TA page).

An exit interview was conducted with Henrietta “Candy” Chong, to whom a copy of this report, the LIC 809-D pages, the LIC421-IM page, the LIC9102-TV page, the LIC9102-TA page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today's visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
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