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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604345
Report Date: 02/23/2023
Date Signed: 02/24/2023 08:12:39 AM


Document Has Been Signed on 02/24/2023 08:12 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:RANCHO DIGIUSFACILITY NUMBER:
374604345
ADMINISTRATOR:MONTES, FROILANFACILITY TYPE:
735
ADDRESS:2445 BROADWAYTELEPHONE:
(619) 468-5700
CITY:SAN DIEGOSTATE: CAZIP CODE:
92102
CAPACITY:49CENSUS: 47DATE:
02/23/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:13 PM
MET WITH:Administrator, Froilan MontesTIME COMPLETED:
06:05 PM
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Licensing Program Analyst (LPA), Natasha Persaud concluded the investigation regarding the above mentioned allegations. LPA met with Administrator, Froilan Montes.

During today’s visit, LPA briefly toured the facility and observed some clients in care. The reason for the visit was to issue deficiencies that were identified during a complaint investigation. During the complaint investigation, it was discovered the facility did not have medication records for clients. The administrator stated there were issues with the pharmacy, and they did not obtain the Medication Administration Records from the pharmacy. The facility also did not complete or maintain a Centrally Stored Medication Destruction Record for clients. The administrator admitted the facility had multiple medication issues in May 2022 and June 2022 and some clients did not receive their medications as prescribed. Staff interviews confirmed clients went without medications but stated the reason was issues with the pharmacy. The administrator confirmed the facility is currently using a different pharmacy and the issues have been resolved. Also, the facility did not report any of the medication issues to Community Care Licensing, as required in Title 22 Regulations. In addition, the facility staff sent a client on a home visit with another client’s medications. Staff admitted the incorrect medications were provided to the incorrect client, who shared the same last name. Staff explained they were busy dispensing medications to other clients and felt rushed by the client’s responsible party and they grabbed the client’s medications along with another client’s medications.

Based on interviews and record review, deficiencies are cited on the attached LIC 809D. A Civil Penalty is being assessed for a repeat violation within a 12 month period. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) and LIC 421FC were provided to Administrator, Froilan Montes whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
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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Document Has Been Signed on 02/24/2023 08:12 AM - 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: RANCHO DIGIUS
FACILITY NUMBER: 374604345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/23/2023
Section Cited

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Health Related Services. The following requirements shall apply to medications which are centrally stored: he licensee shall ensure the maintenance, for each client, of a record of centrally stored prescription medications which is retained for at least one year and includes the following. This requirement is not met as evidenced by:
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Administrator will complete and submit a Centrally Stored Medication and Destruction Record for 5 clients, that still reside at the facility by POC due date.

A civil penalty is being assessed for a repeat violation within a 12 month period.
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Based on interviews and record review, the licensee did not maintain records of centrally stored medications for 6 out of 42 clients in care. This posed a potential health and safety risk to clients in care.
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Type B
03/23/2023
Section Cited

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Personnel Requirements. Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement is not met as evidenced by:
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Administrator agreed to have staff that dispense medications attend medication training by a professional vendor and provide proof of training by POC due date.
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Based on interviews and record review, the licensee did not ensure 1 out of 42 clients received their own medications when a client was given another client’s medications. This posed a potential health and safety risk to clients 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.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 02/24/2023 08:12 AM - 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: RANCHO DIGIUS
FACILITY NUMBER: 374604345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/23/2023
Section Cited

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Reporting Requirements. Upon the occurrence...a report shall be made to the licensing agency...its normal business hours. In addition, a written report...shall be submitted to the licensing agency within seven days following the occurrence of such event.
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Administrator will attend training on Reporting Requirements and provide proof of training by POC due date.
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This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not report medication errors for 6 out of 42 clients in care. This posed a health and safety risk to clients 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.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
LIC809 (FAS) - (06/04)
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