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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604987
Report Date: 08/28/2026
Date Signed: 08/28/2026 10:40:00 PM

Document Has Been Signed on 08/28/2026 10:40 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:CARING HOME CAREFACILITY NUMBER:
374604987
ADMINISTRATOR/
DIRECTOR:		NGUYEN, MEGANFACILITY TYPE:
740
ADDRESS:6052 BROOKLYN AVETELEPHONE:
(619) 861-9902
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 6CENSUS: 2DATE:
08/28/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Administrator/Licensee, Zhiko PruettTIME VISIT/
INSPECTION COMPLETED:
09:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced Case Management visit to follow up on the Death Report submitted to Community Care Licensing (CCL) on August 27, 2026, regarding Resident 1 (R1).

LPA was allowed entry into the facility by Caregiver Kaitlin Rodriquez. LPA contacted Administrator Megan Nguyen by telephone and discussed the purpose of the visit. Licensee/Administrator Zhike Pruett arrived at the facility during the visit, and LPA explained the purpose of the visit to her.

During the visit, LPA determined that Caregiver Kaitlin Rodriquez and five (5) additional caregivers providing care and supervision to residents were not associated with the facility in the Guardian system.

LPA conducted a tour of the facility. Administrator Megan Nguyen agreed to provide the requested facility records electronically by close of business on August 28, 2026.

Deficiencies were issued during today's visit, as documented on the LIC 809D, Deficiency Report. An immediate civil penalty in the amount of $2,000 was also assessed, as documented on the LIC 421, Civil Penalty Assessment. Plan of correction was developed with Licensee, Pruett.

An exit interview was conducted with Licensee/Administrator Zhike Pruett. The Licensee/Administrator was provided copies of this report, LIC 809D, Deficiency Report, LIC 421, Civil Penalty Assessment, and LIC 9058, Licensee/Appeal Rights (03/22).
Sabel Martinez
Marisela Garcia-Centeno
DATE: 08/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 08/28/2026 10:40 PM - It Cannot Be Edited


Created By: Marisela Garcia-Centeno On 08/28/2026 at 06:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: CARING HOME CARE
FACILITY NUMBER: 374604987

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/04/2026
Section Cited
CCR
87355(e)(B)(3)

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87355 Criminal Record Clearance(e)All individuals subject to a criminal record review… shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance…
This requirement was not met as evidenced by:
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The staff members will be associated by POC deadline
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Based on interview and record review, the licensee allowed five (5) staff (S1-S4) to work in the facility prior to completing a criminal record clearance transfer. This posed an immediate health, safety and personal rights risk to 2 of 2 residents in care (R2-R3)
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Type A
08/28/2026
Section Cited
CCR87355(e)(2)

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87355 Criminal Record Clearance(e) All individuals subject to a criminal record review… shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption…
This requirement was not met as evidenced by:
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The staff (S5) was immediately removed from the facility. In addition, Licensee agreed to conduct criminal record clearances prior to hiring furture staff.
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Based on interview and record review, the licensee allowed one staff (S5) to work in the facility despite being denied a criminal record clearance and exemption. This posed an immediate health, safety and personal rights risk to 1 of 2 Residents in care (R1-R2).
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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.
Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:
Marisela Garcia-Centeno
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/28/2026 10:40 PM - It Cannot Be Edited


Created By: Marisela Garcia-Centeno On 08/28/2026 at 06:47 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: CARING HOME CARE
FACILITY NUMBER: 374604987

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/28/2026
Section Cited
CCR
87412(a)

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87412 Personnel Records (a)The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee…
This requirement was not met as evidenced by:
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Licensee agreed to maintain complete personnel records as required by Title 22 regulations. Documentation of personnel records will be submitted to CCL by POC deadline.
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Based on interview and record review, the Licensee was unable to furnish records to the Department as requested for three staff (S1-S3). This posed a potential health, safety and personal rights risk to 2 of 2 Residents in care (R1-R2).
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Type B
09/28/2026
Section Cited
CCR87506(a)

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87506Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.
This requirement was not met as evidenced by:
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Licensee agreed to obtain and maintain complete records in the facility for all residents. In addition, licensee agreed to retain the records for three (3) per Title 22 regulations. Documentation will be submitted to CCL by POC deadline.
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Based on interview and record review, the Licensee was unable to furnish records to the Department for one recently deceased resident (R1). This posed a potential health, safety and personal rights risk to 2 of 2 Residents in care (R1-R2).
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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.
Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:
Marisela Garcia-Centeno
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2026


LIC809 (FAS) - (06/04)
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