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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032701016
Report Date: 02/03/2023
Date Signed: 02/03/2023 12:20:06 PM

Document Has Been Signed on 02/03/2023 12:20 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:POPPY LANE CARE HOMEFACILITY NUMBER:
032701016
ADMINISTRATOR:COCJIN, AARONFACILITY TYPE:
735
ADDRESS:100 POPPY LANETELEPHONE:
(559) 360-9058
CITY:IONESTATE: CAZIP CODE:
95640
CAPACITY: 4CENSUS: 0DATE:
02/03/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Aaron Cocjin, Angelo Ferrer, and Rosemarie Ferrer TIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christina Valerio and LPA Vincent Moleski arrived announced to the facility to conduct a closure visit. LPA met with Administrator Aaron and Licensee Angelo/Rosemarie, and explained the purpose of visit.

Upon arrival, Licensee Angelo and Rosemarie stated they do not want to close the facility since they will continue to be vendorized by Valley Mountain Regional Center (VMRC). LPA explained the purpose of the visit was to close the facility since they initiated the closure process. Licensee stated they are requesting to have an office meeting before moving forward.

On November 15, 2022, LPA was made aware of staffing issues at the facility. VMRC was made aware of the situation on 11/10/22. During that time, it was conveyed that the facility needed to relocate the residents because the licensees were going to retire and there would be no staff in the upcoming weeks. VMRC was able to do an emergency respite placement for the residents in care. All residents were relocated on 12/13/22. After residents were relocated, the Licensee/Administrator stated they did not want to close the facility and continue to keep it licensed without residents in care. Based on this information, the facility will be cited for illegally evicting the residents.

LPAs did not observe any residents in care.

Per California Code of Regulation (CCR), Title 22, Division 6, Chapter 6, deficiencies are being cited today on LIC 809-D. Appeal Rights were provided. An exit interview was held, and a copy of the report was given. LPA Valerio to schedule an office meeting at a later date to discuss current concern.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2023
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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Document Has Been Signed on 02/03/2023 12:20 PM - It Cannot Be Edited


Created By: Christina Valerio On 02/03/2023 at 11:58 AM
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
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: POPPY LANE CARE HOME
FACILITY NUMBER: 032701016

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/04/2023
Section Cited
CCR
85068.5(a)

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85068.5 Eviction Procedures (a) The licensee shall be permitted to evict a client by serving the client with a 30-day written notice to quit for any of the following reasons...This requriement was not met as evidenced by:
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Licensee stated they will review 85068.5. Licensee will send a letter of acknowledgment of their understanding of the regulations by POC due date.
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Based on interviews and observation, the licensee did not ensure to follow eviction procedures for 3 out of 3 residents, which poses an immediate health and safety risk 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:Stephen Richardson
LICENSING EVALUATOR NAME:Christina Valerio
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2023


LIC809 (FAS) - (06/04)
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