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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604345
Report Date: 01/30/2024
Date Signed: 01/30/2024 01:08:20 PM


Document Has Been Signed on 01/30/2024 01:08 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:RANCHO DIGIUSFACILITY NUMBER:
374604345
ADMINISTRATOR:MONTES, FROILANFACILITY TYPE:
735
ADDRESS:2445 BROADWAYTELEPHONE:
(619) 468-5700
CITY:SAN DIEGOSTATE: CAZIP CODE:
92102
CAPACITY:49CENSUS: 48DATE:
01/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator Froilan MontesTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Frolian Montes.

Today's visit was in response to two (2) LIC624 Incident Reports, which licensee self-submitted to the CCLD San Diego Regional Office (received on 01/25/2024 and 01/29/2024, respectively). According to the first LIC624: On 01/19/2024, Licensee’s staff learned that Client #1 (C1) was a missing person, after C1’s relative reported that they had not had contact with C1 for a few days. [See LIC811 Confidential Names List for a description of C1.] Staff notified local police and C1’s case management agency that same day. According to the second LIC624, which provided more details: C1 left the facility on 01/15/2024, presumably to go with their relative. C1 was subsequently hospitalized on 01/15/2024 and then died that same day, which Licensee first learned of on 01/29/2024.

During today’s visit, LPA performed a brief facility tour and welfare check on the remaining clients, finding no immediate safety concerns. LPA also collected copies of and reviewed pertinent care records and interviewed relevant staff.

According to C1’s latest LIC602 Physician’s Report (dated 02/07/2023), C1 was diagnosed with Schizophrenia, but their doctor determined that C1 was not confused, not depressed, able to follow instructions, able to communicate, and able to safely leave the facility unassisted. LPA observed that Licensee possessed a written Absentee Notification Plan as part of C1’s record of care.


[CONTINUED ON LIC 809-C]

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2024
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


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
VISIT DATE: 01/30/2024
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[CONTINUED FROM LIC 809]

Per manager interview: The specific circumstances leading up to C1’s hospitalization and death are currently unknown to Licensee. C1’s official cause of death is pending investigation from the San Diego County Medical Examiner.

No deficiencies were cited during today's visit.

An exit interview was conducted with Montes, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC809 (FAS) - (06/04)
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