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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604275
Report Date: 03/20/2025
Date Signed: 03/20/2025 10:41:45 AM

Document Has Been Signed on 03/20/2025 10:41 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:REHOBOTH HOMESFACILITY NUMBER:
374604275
ADMINISTRATOR/
DIRECTOR:		GONZALEZ JR, EDUARDOFACILITY TYPE:
735
ADDRESS:936 REDBUD RDTELEPHONE:
(619) 349-3131
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 4CENSUS: 4DATE:
03/20/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Roxana Rios TIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Case Management Visit.  LPA was greeted by and met with Direct Support Professional (DSP) Roxana Rios, to discuss the purpose of the visit.

Today's visit is in response to the self reported medication errors for Client 1 (C1) (see LIC811 Confidential List of Names) received on February 28, 2025 and March 6, 2025. It was reported on February 28, 2025 Staff 1 (S1) administered the wrong nasal spray inhaler to C1. One being the "daily dose" nasal spray and the other being the "PRN" nasal spray. The correct nasal spray was administered to C1 an hour later without incident It was reported on March 6 2025 that C1 was given their GERD medication by Staff 2 (S2) that fell from C1's lips to the floor. Both S2 and C1 attempted to locate the medication, but it was not found. S1 had provided C1 with the last available pill from the cycle. The pharmacy was called and a replacement pill was to be received on March 6, 2025. A medication training was conducted by Administrator on March 1, 2025 that S1 attended.

Records review of C1's Physician's Report revealed that C1 has a primary diagnosis of mild intellectual development disorder and although C1 is able to administer and store their medications the facility is required to store and dispense the medication to C1.

LPA interviewed staff and collected records.. No deficiencies were cited or observed on this date. 

An exit interview was conducted with Roxana Rios who was provided with a copy of this report and Appeal Rights (LIC9056 03/22). Their signature confirms receipt of these documents.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2025
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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