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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601332
Report Date: 05/28/2024
Date Signed: 05/28/2024 01:40:41 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2021 and conducted by Evaluator Ramon Serrano
COMPLAINT CONTROL NUMBER: 08-AS-20210325085111
FACILITY NAME:ROYAL GARDEN GUEST HOMEFACILITY NUMBER:
374601332
ADMINISTRATOR:RODOLFO TABLADILLOFACILITY TYPE:
740
ADDRESS:39 G STREETTELEPHONE:
(619) 420-0830
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:6CENSUS: 3DATE:
05/28/2024
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Rudy TabladilloTIME COMPLETED:
01:59 PM
ALLEGATION(S):
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Facility is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with Administrator Rudy Tabladillo to whom LPA explained the purpose of the visit.

Community Care Licensing (CCL) has investigated the above listed complaint allegations. The investigation consisted of LPA direct observation and interviews with staff and residents.

It was alleged that the facility was in disrepair. It was reported that the facility had piles trash and "junk" in the back yard area. LPA’s observation confirmed that the outside of the facility was indeed in disrepair. Piles of junk and bags of recyclable trash were visible in the back yard area, contributing to an unsightly and potentially hazardous environment. The allegation of facility disrepair was substantiated based on visual evidence.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 08-AS-20210325085111
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ROYAL GARDEN GUEST HOME
FACILITY NUMBER: 374601332
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2024
Section Cited
CCR
87303(a)
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87305(a)- The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met, as evidenced by:
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Licensee agreed they will submit a written plan for obtaining trash removal services with estimated completion date by POC date.
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Based on LPA observations licensee did not maintain a clean and sanitary yard. This posed a potential health and safety risk to 3 in 3 residents 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.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2021 and conducted by Evaluator Ramon Serrano
COMPLAINT CONTROL NUMBER: 08-AS-20210325085111

FACILITY NAME:ROYAL GARDEN GUEST HOMEFACILITY NUMBER:
374601332
ADMINISTRATOR:RODOLFO TABLADILLOFACILITY TYPE:
740
ADDRESS:39 G STREETTELEPHONE:
(619) 420-0830
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:6CENSUS: 3DATE:
05/28/2024
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Rudy TabladilloTIME COMPLETED:
01:59 PM
ALLEGATION(S):
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9
Facility did not address the infestation of pest
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with Licensee Rudy Tabladillo, to whom LPA explained the purpose of the visit.

Community Care Licensing (CCL) has investigated the above listed complaint allegations. The investigation consisted of LPA direct observation and interviews with staff and residents.

It was alleged that the facility had a pest infestation due to piles of junk in the yard. LPA inspected the facility for signs of pest infestation. No evidence of pests (such as rodents or insects) was found during the visit.





Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20210325085111
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ROYAL GARDEN GUEST HOME
FACILITY NUMBER: 374601332
VISIT DATE: 05/28/2024
NARRATIVE
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LPA interviewed Administrator who stated that his neighbor advised him a couple of years prior that a rodent was seen going into his yard from the back of the facility. Administrator stated that immediately after he was informed he cleaned up the back area. Administrator stated that the facility has an ongoing contract with a pest control company. Administrator further stated that the pest control company visited the facility last week and "treated" the facility perimeter and surrounding areas.

Based upon the foregoing, the above listed allegation is unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegation is not valid.

An exit interview was conducted with Rudy Tabladillo. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Rudy Tabladillo whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20210325085111
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ROYAL GARDEN GUEST HOME
FACILITY NUMBER: 374601332
VISIT DATE: 05/28/2024
NARRATIVE
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Based upon the foregoing, the above listed allegation is substantiated. This finding means that the preponderance of the evidence standard has been met and the allegations are valid. Deficiencies are cited in accordance with California Code of Regulations, Title 22 and are noted on the attached LIC 9099-D.

An exit interview was conducted with Rudy Tabladillo and a copy of this report and Licensee/Appeal Rights (LIC9058, 3/22) were provided to Rudy Tabladillo whose signature below confirms receipt of documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5