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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200883
Report Date: 04/03/2024
Date Signed: 04/03/2024 02:13:55 PM

Document Has Been Signed on 04/03/2024 02:13 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:LA CALLE HAVENFACILITY NUMBER:
079200883
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		LIPARDO, MELISSAFACILITY TYPE:
735
ADDRESS:1775 LA CALLETELEPHONE:
(925) 822-3610
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 6CENSUS: 6DATE:
04/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Bernadette Aguila, AdministratorTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On 04/03/2024 at 11:35 AM Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Case Management visit regarding information that was received to the Department on 04/02/2024. LPA met with Manuel "Manny" Cabor and explained the purpose of the visit. Manny phoned the Administrator, Bernadette Aguila to inform. Bernadette arrived at the facility approximately 11:51 AM. LPA informed Bernadette why the visit today. Bernadette then called the Licensee, Melissa Lipardo to inform the reason for the visit.

On 04/02/2024 the Department received information that the Licensee filed for bankruptcy but there is no record that Community Care Licensing Division (CCLD) was notified. LPA spoke with the Licensee over the phone and Licensee stated that her attorney and judge did not advise to notify CCLD. Licensee stated that she notified Regional Center of the East Bay (RCEB). Licensee stated that the bankruptcy is for Chapter 11; reorganization. Licensee stated that the operation is still operating normal.

Documents obtained:
  1. Resident Registry List
  2. Personnel Report (LIC500)

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiencies by POC date may result in additional Civil Penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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 04/03/2024 02:13 PM - It Cannot Be Edited


Created By: Lori Alexander-Washington On 04/03/2024 at 12:50 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
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: LA CALLE HAVEN
FACILITY NUMBER: 079200883

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/10/2024
Section Cited
HSC
1562.2

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ยง1562.2 (b) A licensee of an adult residential facility shall inform the city and county in which the facility is located, the department, all residents, and, if applicable, their legal representatives, in writing, within two business days, and shall notify all applicants for potential residence, and, if applicable, their legal representatives, prior to admission, of any of the following events, or knowledge of the event: (3) The licensee files for bankruptcy.

This requirement is not met as evidenced by:
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Licensee agree to self-certify that they read and understand the regulation moving forward. In addition, Licensee will submit formal letter to CCLD with a copy of Bankruptcy and proof that all entities including residents and their legal representatives have been notified.
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Based on record review and interview the licensee did not comply with the section cited above in not notifying CCLD which poses an immediate health, safety or personal rights risk to persons in care.
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Licensee will submit POC to CCLD by POC due date.

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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:Bennett Fong
LICENSING EVALUATOR NAME:Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024


LIC809 (FAS) - (06/04)
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