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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604650
Report Date: 05/03/2024
Date Signed: 05/03/2024 03:05:29 PM

Document Has Been Signed on 05/03/2024 03:05 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:D & G GUEST HOMEFACILITY NUMBER:
374604650
ADMINISTRATOR/
DIRECTOR:		AQUINO, RODELIOFACILITY TYPE:
740
ADDRESS:2150 WASHINGTON STREETTELEPHONE:
(619) 913-1100
CITY:LEMONG GROVESTATE: CAZIP CODE:
91945
CAPACITY: 6CENSUS: 0DATE:
05/03/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Licensee Joseph Gaerlan and Administrator Rodelio AquinoTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Amy Rodgers conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified herself to, and explained the purpose of the visit to the applicant’s Licensee Joseph Gaerlan and Administrator Rodelio Aquino..

The facility fire clearance was granted on 12/21/2023 and reflected that the facility was approved for six (6) residents in total, of which two (2) may be non-ambulatory. On the date of LPA's site visit, there were no residents in care. The submitted facility sketch was consistent with the current layout of the facility.

During today’s visit, LPA, accompanied by the Licensee, toured the interior and exterior of the facility and inspected all rooms. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order.



The facility’s ambient internal temperature was compliant at 75 degrees F. Hot water temperature at taps accessible to residents were also compliant. There was 7 days supply of non-perishable food however due to zero occupancy there were no perishable food supplies on site. All kitchen appliances were in working order. There is only one freezer refrigerator combo in the home and the temperature of said appliance was compliant.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: D & G GUEST HOME
FACILITY NUMBER: 374604650
VISIT DATE: 05/03/2024
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The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records. The facility has enough linens, hygiene supplies, cooking and dining supplies.

No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per the Licensee, no firearms or ammunition are or will be stored at the facility.

Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. Fire extinguishers were serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility.

The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection.

LPA also provided the Component III Training during today’s visit. Licensee Gaerlan was advised that the facility’s application is pending management final review and approval.

An exit interview was conducted with Licensee Gaerlan, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC809 (FAS) - (06/04)
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