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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002806
Report Date: 05/11/2023
Date Signed: 05/11/2023 04:19:45 PM


Document Has Been Signed on 05/11/2023 04:19 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
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:SPRINGVIEW ELDERLY CAREHOMEFACILITY NUMBER:
315002806
ADMINISTRATOR:ARCEGA, LOVELIEFACILITY TYPE:
740
ADDRESS:5536 GRAHAM CT.TELEPHONE:
(916) 672-6945
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 2DATE:
05/11/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lovelie ArcegaTIME COMPLETED:
03:20 PM
NARRATIVE
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On 5/11/23, Licensing Program Analyst (LPA), Kevin Mknelly, Regional Manager, Alycia Berryman and Licensing Program Manager, Laura Munoz were present for a Non-compliance Conference via Microsoft Teams today with Licensee Myles Parkinson.

Mr. Parkinson did not arrive for the meeting. This was the second attempt at this meeting. In communication between LPA Mknelly and licensee on 4/27/23, the licensee selected this day and time for the meeting. Attempts were made to phone and email the licensee during the meeting. There was no response to the messages during the time of the meeting. Present representing the facility was Administrator, Lovelie Arcega.

A complaint was submitted to the Department on 11/22/22, alleging financial distress. When licensee was undergoing financial distress in operating this facility due to a , as found through a Department audit, licensee was also found to had not informed the department of their financial distress as required in CCR 87211(d) (4). Records and statements found licensee currently in default of rent payment and a unlawful detailer has been filed by the property owner.

As a result of this visit, the following deficiencies were cited, per Title 22 Regulations, Division 6. The following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk to clients/residents in care.

This report is delivered via email to Administrator for review and signature.Appeals rights printed.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2023
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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Document Has Been Signed on 05/11/2023 04:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833


FACILITY NAME: SPRINGVIEW ELDERLY CAREHOME
FACILITY NUMBER: 315002806

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2023
Section Cited

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Reporting Requirements (d) The licensee shall notify the Department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their representatives, in writing within two business days of any of the following specified events, or knowledge thereof: (4) The licensee receives a written notice of default of payment of rent described in Section 1161 of the Code of Civil Procedure.
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Licensee will submit a written statement of understanding this requirement as well reliable contact information where they may be reached by the department.

The POC is due by 5/15/23

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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: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2023
LIC809 (FAS) - (06/04)
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