157206719-11-8-2023-24-AS-SPIY-CY3MAY-20231130082708

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157206719
Report Date: 11/08/2023
Date Signed: 11/08/2023 07:45:40 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/02/2023 and conducted by Evaluator Darius Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20231102123111

FACILITY NAME:	PARK RCFE, THE		FACILITY NUMBER:	157206719
ADMINISTRATOR:	MALONE, CATHY		FACILITY TYPE:	740
ADDRESS:	311 GARNSEY AVENUE		TELEPHONE:	(661) 283-4160
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93309
CAPACITY:	9	CENSUS: 5	DATE:	11/08/2023
		UNANNOUNCED	TIME BEGAN:	01:32 PM
MET WITH:	Licensee, Cathy Malone		TIME COMPLETED:	03:06 PM

ALLEGATION(S):

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Facility did not issue resident a correct refund amount.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced complaint visit. LPA met with Administrator Cathy Malone and discussed the purpose of the visit.

LPA conducted interviews and record reviews.

Resident 1's paid rent of $4800 for September 2023. R1's belongings were removed by the Authorized Representative on 9/18/2023. A refund of $1920 is owed to the AR, at a rate of $160 a da, between 9/19/2023 and 9/30/2023.

Additionally, a deposit was accepted of $4400 when R1 moved in. A refund of $4400 is owed to the AR, as Title 22 California Code of Regulations, does not allow a deposit to be accepted against any possible damages by the resident.

*Continued on LIC 9099-C*

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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 24-AS-20231102123111

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PARK RCFE, THE	FACILITY NUMBER: 157206719
	VISIT DATE: 11/08/2023

NARRATIVE

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Licensee stated she is going to modify the Admission Agreement be in compliance with refund policy.

Based on LPAs interviews and record reviews, the preponderance of evidence standard has been met, therefore the allegation, facility did not issue resident a correct refund amount, is found to be SUBSTANTIATED. California Code of Regulations, Title 22 violations, are being cited on the attached LIC 9099D.

Plan of correction was reviewed and discussed with Licensee.

An exit interview was conducted and a copy of this report and appeal rights will be provided via e-mail.

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

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Control Number 24-AS-20231102123111

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PARK RCFE, THE	FACILITY NUMBER: 157206719
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/23/2023 Section Cited HSC 1669.652(a)	1 2 3 4 5 6 7	(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued... within 15 days after the personal property is removed. This requirement was not met evident by:	1 2 3 4 5 6 7	Licensee agreed to provide a refund of $1920 to R1's representative, by POC due date of 11/23/2023. Licensee stated a certified cashier check will be provided.
	8 9 10 11 12 13 14	Based on LPA interview and record review, the Licensee did not ensure to provide a refund, for advance payment, to R1's Represenative after property was removed on 9/18/2023, which poses a potential personal rights risk to person's in care.	8 9 10 11 12 13 14
Type B 11/30/2023 Section Cited CCR 87507(g)(3)(C)(4)	1 2 3 4 5 6 7	4. A licensee shall not require, request, or accept any funds from a resident or a resident’s representative, if any, that constitutes a deposit against any possible damages by the resident. This requirment was not met evident by:	1 2 3 4 5 6 7	Licensee agreed to provide a refund of $2615, previous amount of $1785 has already been provided, to R1's representative, by POC due date of 11/30/2023. Licensee stated a certified cashier check will be provided.
	8 9 10 11 12 13 14	Based on LPA interview and record review, the Licensee accepted a deposit of $4400 from R1 authorized representative, which poses a potential personal right risk to persons in care.	8 9 10 11 12 13 14

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: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

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