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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881394
Report Date: 02/06/2025
Date Signed: 02/06/2025 02:08:21 PM

Document Has Been Signed on 02/06/2025 02:08 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:DOLORE HOMEFACILITY NUMBER:
371881394
ADMINISTRATOR/
DIRECTOR:		ARACELI SONGCOFACILITY TYPE:
740
ADDRESS:1412 DOLORE PLACETELEPHONE:
(619) 717-1574
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 6CENSUS: 5DATE:
02/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:44 AM
MET WITH:Arceli Songco, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 02/06/25 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a 1 year required visit. LPA was greeted and granted entry by caregivers Leonia and Leonardo Dizon, the Administrator Arceli Songco arrived an hour after LPA arrival, with the resident files, and staff files. LPA discussed the need to have the files at the facility available for review by the department, and that they should be brought at a reasonable time LPA explained the purpose of the visit and verified the facility's contact information that is on file with the department.

At the time of the visit there was (3) staff and (5) residents present. LPA was only able to conduct (1) interview as all residents were asleep. The residents are under the weather with symptoms of a cold. The facility is licensed to serve residents age 60 and over with an approved fire clearance for (6) of which (1) may be bedridden and reside in bedroom #1. The facility has an approved hospice waiver for (6) with (3) residents currently receiving hospice services.

The facility is a single story home consisting of 5 bedrooms, a caregiver room, and 2 bathrooms, garage, kitchen, garage, backyard with covered patio. The facility was observed to be clean and clutter free. There are no pools or bodies of water on the premises. The resident rooms had the required furnishings such as bed and chest of drawers.

The facility food supply was observed to be adequate as there was a (2) day supply of perishable and a (7) day supply of nonperishable food items. All staff were observed to have obtained criminal record clearance and to be associated to the facility. Arceli's Administrator certificate is valid and expires on 08/29/25. The staff were observed to have active Cardio Pulmonary Resuscitation (CPR) training. The governing body is active and in good standing, and the facility annual fees are due by 02/24/25, LPA provided PIN#964477, should the Licensee wish to pay electronically.

The medications were observed to be locked and inaccessible to residents in care. The combined smoke and carbon monoxide detectors were tested and observed to be operable. The last emergency disaster drill was
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: DOLORE HOME
FACILITY NUMBER: 371881394
VISIT DATE: 02/06/2025
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conducted on 01/05/25. There are no known guns or ammunition on the property. The facility liability insurance expires 10/16/25.

Note: The hot water temperature was unable to be tested/measured due to LPAs thermometer malfunctioning and there was not another thermometer available to use at the facility.

Based on today's inspection there were no deficiencies cited, and no citations were issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted and a copy of this report was reviewed and provided to Arceli Songco, Administrator.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
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