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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202172
Report Date: 07/15/2024
Date Signed: 07/16/2024 09:34:24 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 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
05/16/2024 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20240516114225
FACILITY NAME:CRISTINE'S GUEST HOME IIIFACILITY NUMBER:
275202172
ADMINISTRATOR:MA CRISTINA DEL ROSARIOFACILITY TYPE:
740
ADDRESS:1312 NOGAL DRIVETELEPHONE:
(831) 998-7085
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY:6CENSUS: 4DATE:
07/15/2024
UNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Licensee, Cristine Del RosarioTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Illegal eviction.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility to investigate a complaint on the allegations above. LPA met with facility Licensee, Cristine Del Rosario and explained the purpose of today's visit.

Regarding the allegation illegal eviction. LPA Hurt reviewed the eviction letter given to Resident 1 by facility Licensee on April 29, 2024. The eviction letter does not have an effective date Resident 1 is to vacate the facility. Based on records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.


The following deficincies are being cited Per Title 22 Regulations. Exit interview conducted with Licensee Cristine Del Rosario, and a copy of this report provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 24-AS-20240516114225
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: CRISTINE'S GUEST HOME III
FACILITY NUMBER: 275202172
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/29/2024
Section Cited
CCR
87224(a)(1)(A)
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87224 Eviction Procedures(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5)(1) The notice to quit shall include the following information: (A)The effective date of the eviction.
The following requirement has not been met as evidenced by:
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Licensee will update eviction letter, and re submit to Licensing by 07/29/2024, and review Title 22 Regulation 87224 (a)(1)(A) and submit letter of understanding to LPA by POC date.
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Licensee gave Resident 1 eviction notice that does not include the effective date of the eviction, which poses a potential, health, safety, or personal rights 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: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC9099 (FAS) - (06/04)
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