315001487-5-7-2021-27-AS-MSEY-C3DTTC-20210526150030

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315001487
Report Date: 05/07/2021
Date Signed: 05/07/2021 05:01:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/14/2020 and conducted by Evaluator Todd Tryon

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200914110351

FACILITY NAME:	JABEZ HOMESTEAD		FACILITY NUMBER:	315001487
ADMINISTRATOR:	SAMANTHA CORKER		FACILITY TYPE:	740
ADDRESS:	1720 LILAC LANE		TELEPHONE:	(530) 888-8620
CITY:	AUBURN	STATE: CA	ZIP CODE:	95603
CAPACITY:	0	CENSUS: 0	DATE:	05/07/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Kim Cavender		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Residents not given proper eviction notices

INVESTIGATION FINDINGS:

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On 5/6/2021 LPA Tryon met with former licensee Kim Cavender to go over the results of the complaint. The meeting was held by phone due to concerns related to COVID-19.
LPA has interviewed licensee and reviewed Eviction Notice letter sent out on 9/11/20. As per review of the letter, LPA found that the letter was dated 9/11/20, and said that the facility had an estimated closing date of 10/1/20. Therefore, the letter did NOT give 60-day notice, and is not a proper eviction as per regulation. Allegation is substantiated. A finding of SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.
The following deficiency is cited as per Health and Safety Code 1569.682 (a)(2). Exit interview conducted, Appeal rights provided.
Due to concerns related to COVID, this report will be e-mailed to the licensee. Licensee has been asked to print out two copies, sign both, keep a copy and return a signed copy to CCL for agency records. A hard copy of the report with signature will be retained in facility file.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd Tryon	TELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021

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 27-AS-20200914110351

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: JABEZ HOMESTEAD	FACILITY NUMBER: 315001487
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/06/2021 Section Cited HSC 1569.682(a)(2)A-F	1 2 3 4 5 6 7	The licensee issued an eviction notice due to the facility planned to close. The original eviction letter was dated 9/11/20; and estimated closure date was listed as 10/1/20. By review of documenation and interview of licensee, it was found that the letter did NOT give a 60-day notice for residents to move.	1 2 3 4 5 6 7	The licensee must givve at least 60-day Notice of eviction prior to facility closure, in addition to other requirements as per regulation. The facility was directed to rescind the letter in question and issue a new, corrected Eviction Letter. The licensee did issue a new letter dated 9/18/20 giving a 60-day notice.
	8 9 10 11 12 13 14		8 9 10 11 12 13 14	POC is complete.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd Tryon	TELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021

LIC9099 (FAS) - (06/04)

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