019200464-4-22-2021-15-AS-KHOS-C2JHWG-20210429063330

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200464
Report Date: 04/22/2021
Date Signed: 04/22/2021 08:03:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/08/2021 and conducted by Evaluator Allison O'Hollaren

COMPLAINT CONTROL NUMBER: 15-AS-20210208145014

FACILITY NAME:	J & C CARE CENTER LLC		FACILITY NUMBER:	019200464
ADMINISTRATOR:	CHING, JESSICA		FACILITY TYPE:	740
ADDRESS:	4240 REDDING STREET		TELEPHONE:	(510) 482-0108
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94619
CAPACITY:	25	CENSUS: 21	DATE:	04/22/2021
		UNANNOUNCED	TIME BEGAN:	07:35 PM
MET WITH:	Jessica Ching		TIME COMPLETED:	08:05 PM

ALLEGATION(S):

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Ilegal eviction

INVESTIGATION FINDINGS:

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On 04/22/2021 Licensing Program Analyst (LPA) Allison O'Hollaren conducted an announced visit with Administrator Jessica Ching to deliver investigation findings on the above allegation. Due to State's current shelter in place order pertaining to COVID-19 it was not possible to perform this visit at the facility. The visit was performed by telephone.

During the course of the investigation, LPA interviewed Adminstrator Jessica Ching who stated that Resident R1 was admitted to the facility on 01/21/2021. Text message records revealed that Administrator Jessica Ching texted a family member of R1 on 02/01/2021 stating, "If we did not receive payment we will send [R1] back to Kaiser." On 02/11/2021 Administrator Jessica Ching confirmed the text message sent on 02/01/2021.

Continued on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Allison O'Hollaren	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20210208145014

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: J & C CARE CENTER LLC	FACILITY NUMBER: 019200464
	VISIT DATE: 04/22/2021

NARRATIVE

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Interviews that were conducted during the investigation with Reporting Party, two witnesses, and Administrator Jessica Ching all confirm that on 02/08/2021 Administrator Jessica Ching sent R1 to the hospital. Hospital personnel informed LPA that hospital records state that R1 was returned back to the facility from the hospital due to payment.

Based on interviews and record reviewed the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The following deficiency was observed (see LIC 9099-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided via email.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Allison O'Hollaren	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2021

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20210208145014

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: J & C CARE CENTER LLC	FACILITY NUMBER: 019200464
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/22/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/29/2021 Section Cited CCR 87224(a)(1)	1 2 3 4 5 6 7	87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required...(1)	1 2 3 4 5 6 7	By POC date, administrator agrees to review regulation and send a copy of self-certification letter to CCLD by fax or email.
	8 9 10 11 12 13 14	Nonpayment of the rate for basic services within ten days of the due date. This requirement was not met as evidence by: Based on LPA's record review and interviews conducted, Administrator sent R1 to the hospital due to non-payment instead of following eviction procedures which did not comply with the section cited above posing a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Allison O'Hollaren	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2021

LIC9099 (FAS) - (06/04)

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