197605091-8-23-2023-31-AS-APAA-CUYTXW-20230823150749

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197605091
Report Date: 08/23/2023
Date Signed: 08/23/2023 03:07:58 PM

Document Has Been Signed on 08/23/2023 03:07 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	YONG CARE HOME		FACILITY NUMBER:	197605091
ADMINISTRATOR:	GARY JOHNSON		FACILITY TYPE:	740
ADDRESS:	1539 W. AVENUE L-12		TELEPHONE:	(661) 916-9351
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	6	CENSUS: 1	DATE:	08/23/2023
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Gary Johnson, Administrator		TIME COMPLETED:	03:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	The purpose of this meeting was to discuss recent issues of non-compliance. Present at today’s meeting were: Gary Johnson, Administrator, Licensing Program Managers (LPMs), Troy Agard and Nichelle Gillyard and Licensing Program Analysts (LPAs) Angela Panushkina and Melissa Spaeth. The informal conference process was explained to the Licensee and Administrator. Additionally, they were also informed that this Informal Conference is part of the administrative action process and that further non-compliance and/or citations would result in requiring the attendance at a Non-Compliance Conference meeting. Yong Care Home was licensed on 05/21/2004. From the date the facility was licensed to present (08/23/23), the Regional Office (RO) received three (3) complaints. Two (2) out of Three (3) complaints have been found Substantiated. During today’s conference, the following matters were discussed: · Incidental Medical and Dental Care: a. Section: 87465(h)(2) b. Dates: 08/17/23 During the visit conducted on 08/17/23, Administrator refused to provide R1's full file to LPAs by explaining that it is a violation of Personal Rights under the Health and Safety Code (Section 1569.269(3). During today's Informal Meeting *Section 87755 Inspection Authority of the Licensing Agency* from the Continue on LIC809-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: YONG CARE HOME	FACILITY NUMBER: 197605091
	VISIT DATE: 08/23/2023

NARRATIVE

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Title 22 Regulation was explained and discussed with the Administrator. A copy of Section 87755 also provided to the Administrator. The Administrator refused to provide residents record to LPAs in a future based on an updated (2017) Section 1569.269(3) of the Health and Safety Code. In addition, Administrator informed the Department that he's been working with a Vendor, Michael S. Goryan, who provided a lot of good information regarding the law changes/updates. Based on a knowledge that the Administrator received through his vendor, he informed the Department that he will complete an Addendum to the facilitys' Admission Agreement regarding the resident file and access confidentiality. LPMs informed the Administrator that the Addendum can be submitted to the Department and once reviewed it may or may not be approved. LPMs also requested Dementia Plan of Operation to be emailed for a review.

Although, prior history of the citations and plan of corrections were discussed/received, the Licensee was asked what steps will be taken to prevent this from happening again. Licensee/Administrator provided detailed information to the Department.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC809 (FAS) - (06/04)

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