Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit to cite deficiencies which were identified during a separate Complaint Investigation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Alfred Riosa.

Interview of facility manager and outside sources, and records reviewed, aligned to show: Licensee met with the responsible person (RP) for Resident #1 (R1) on 07/18/2022 for a care conference meeting. During this meeting, Licensee personally served RP with an eviction letter titled, “30 Days Notice.” CCLD reviewed a copy of this letter.

Although the Department determined that the basis for R1’s eviction was valid, the contents of Licensee’s eviction letter did not meet all regulatory requirements. Licensee did not include in the letter “a statement informing residents of their right to file a complaint with the licensing agency” and the name, address, and telephone number of the local licensing office and the State Long Term Care Ombudsman office, as was required. Licensee did not include in the letter the required disclosure statement described in California Health and Safety Code Section 1569.683(a)(4), which reads: "In order to evict a resident who remains in the facility after the effective date of the eviction, the residential care facility for the elderly must file an unlawful detainer action in superior court and receive a written judgment signed by a judge. If the facility pursues the unlawful detainer action, you must be served with a summons and complaint. You have the right to contest the eviction in writing and through a hearing." Interviews showed that R1 voluntarily moved out of the facility prior to the expiration of 30-day notice period.

Two (2) deficiencies were cited per California Code of Regulations, Title 22 (see the LIC 809-D page). Plans of Correction were jointly developed with the Licensee.

An exit interview was conducted with Riosa, to whom a copy of this report, the LIC 809-D page, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.