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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200734
Report Date: 08/21/2023
Date Signed: 08/21/2023 10:42:43 AM


Document Has Been Signed on 08/21/2023 10:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:JOY SENIOR CENTERFACILITY NUMBER:
019200734
ADMINISTRATOR:MATHARU, GURPREETFACILITY TYPE:
740
ADDRESS:6400 BRENTWOOD BLVDTELEPHONE:
(510) 543-4695
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:18CENSUS: 13DATE:
08/21/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Rose Constastino, CaregiverTIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) J. Clancy-Czuleger conducted this unannounced visit where Administrator Gupreet Matharu was called to address violations that were found during an investigation conducted by the Department. Gupreet authorized Rose Constastino, Caregiver,to sign off on the report as he was not able to come to the facility.

As part of an investigation related to Complaint Control No. 15-AS-20221207141510, filed on 12/07/22, the Department's Audit Division conducted an Audit for this facility.



The Auditor’s investigation revealed that S1 financially abused R1. On 10/7/2022, S1 took R1 to Bank of the West and closed R1’s old checking account and saving account. The remaining balance was transferred to a new checking and savings account. S1 used R1’s debit card to make unauthorized purchases. The auditor obtained R1’s bank statements from January 2021 to December 2022 detailing the unauthorized purchases by S1. The auditor determined that the total unauthorized purchases on the resident’s card is $31,727.10.

In addition, Administrator did not have any Policies and Procedures in place to safeguard residents’ funds R1 who was only able to manage his cash resources with the help of the licensee. The licensee kept R1’s check books but did not secure R1’s debit card. S1 obtained R1’s debit card and used it for in store and online purchases, utility payment, and cash withdrawals.




Continued on 809-C...
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2023
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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: JOY SENIOR CENTER
FACILITY NUMBER: 019200734
VISIT DATE: 08/21/2023
NARRATIVE
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...Continued from 809
In an interview with the Auditor S2 stated R1’s monthly rent is $3,500 of which $3,087.70 is paid by the VA and R1 paid remaining balance for $412.30. S2 stated “I fill out the check for about $400. R1 signed the checks. R1 can’t write checks. His hands, he can’t brush his teeth. So, I wrote check amount, and he signed it.”

Raised the rate without proper 60-day notice, on 12/1/2022, the licensee sent R1 a rate increase notice. The rate was increased to $4,000 per month effective on 1/1/2023. A licensee is required to provide no less than 60 days’ notice prior to an increase to the basic services rate. The licensee did not follow the rate increase requirement.

Documents that were reviewed by the department show that licensee filed SOC 341 on 08/06/2018 which stated S1 tried to marry R1 and had taken $500 dollars from R1 using his debit card. On 8/7/2018, licensee gave S1 a warning notice and asked S1 to return R1’s debit card.

The facility was not aware of the whereabout of the residents and R1’s outgoing and incoming log stated that R1 did not have activity 08/16/21, 09/13/21, 03/31/22, 10/07/22, when bank statements showing in branch withdrawals from R1 on those dates. Along with 11/14/22 when S1 took R1 to Santa Clara County to legally marry him.

Deficiencies are cited per California Code of Regulations, Title 22, and begins on the next page. Failure to correct deficiencies may result in civil penalties.

Exit interview conducted and a copy of this report and Appeal Rights provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 08/21/2023 10:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612


FACILITY NAME: JOY SENIOR CENTER
FACILITY NUMBER: 019200734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/21/2023
Section Cited
CCR
87468.2(a)(8)

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In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential… or sexual abuse. This requirement is not met as evidenced by:
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A mandatory meeting will be held at a later date.
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S1’s actions of abusing R1’s cash resources. S1 used R1’s debit card to make personal purchases in the amount of $31,727.10.
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Type A
08/21/2023
Section Cited
HSC1569.655(a)

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If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice... This requirement is not met as evidenced by:
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A mandatory meeting will be held at a later date.
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The Licensee gave R1 a rate increase notice on 12/1/22 effective 1/1/23.
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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.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5


Document Has Been Signed on 08/21/2023 10:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612


FACILITY NAME: JOY SENIOR CENTER
FACILITY NUMBER: 019200734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/21/2023
Section Cited
HSC
1569.312(d)

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Every facility required to be licensed under this chapter shall provide at least the following basic services: (d) Being aware of the resident's general whereabouts, although the resident may travel independently in the community. This requirement is not met as evidenced by:
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A mandatory meeting will be held at a later date.
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The facility not having accurate logs of the resident’s ingoing and outgoing activities.
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Type A
08/21/2023
Section Cited
CCR87405(d)(3)

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The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)... (3) Ability to maintain or supervise the maintenance of financial and other records.This requirement is not met as evidenced by:
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A mandatory meeting will be held at a later date.
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Based on record review and interviews by the Department's Auditor, Licensee did not comply with the above regulation by mishandling R1's finances which poses a personal rights issue to 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.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 08/21/2023 10:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612


FACILITY NAME: JOY SENIOR CENTER
FACILITY NUMBER: 019200734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2023
Section Cited
CCR
87205(a)

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The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement is not met as evidenced by:
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A mandatory meeting will be held at a later date.
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Based on record review by the Department's Auditor, Licensee did not comply with the above regulation by having knowledge of the staffs intents back in 2018 and still allowed S1 to work with R1.
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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.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5