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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920034
Report Date: 08/26/2024
Date Signed: 08/26/2024 02:44:48 PM


Document Has Been Signed on 08/26/2024 02:44 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:VITAE HOME CAREFACILITY NUMBER:
315920034
ADMINISTRATOR:ANJANA KUMARIFACILITY TYPE:
740
ADDRESS:6882 BRANDY CIRCLETELEPHONE:
(916) 797-6238
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:6CENSUS: 5DATE:
08/26/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Anjana KumariTIME COMPLETED:
02:45 PM
NARRATIVE
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On 8/26/24, Licensing Program Analysts (LPAs) Kevin Mknelly and Graham Gunby, conducted a case management visit while delivering complaint findings and met with the Administrator.

On 8/21/24, the department received a complaint that unlicensed care was being provided at this home. The licensee is currently in the process of a change of ownership, therefore licensed care is being provided.

During the investigation is was found that the licensee failed to issue 60 day notices to residents of the change of use of the facility and the licensee discontinued their lease of the property while a pending application was in process.

As a result of this inspection, 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, or personal rights violation, to clients/residents in care.

This report was reviewed with the Administrator. Copy of the report and appeal rights provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 08/26/2024 02:44 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: VITAE HOME CARE
FACILITY NUMBER: 315920034

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/27/2024
Section Cited
CCR
87155(a)(7)

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Application for License(a) (7) Name and address of owner of facility premises if applicant is leasing or renting. This requirement was not met based on documents and interview which found the licensee relinquished control of .
This posed immediate risks to residents.
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Licensee will submit a copy of a current lease for the property owner and Golden Age LLA by the POC date of 8/26/24.
Type B
09/09/2024
Section Cited
CCR
87224(a)(5)(A)

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Eviction Procedures.(a)(5) Change of use of the facility.A) The licensee may, upon no less than sixty (60) days written notice, evict a resident due to change of use of the facility. This requirement was not met based on interviews and records review that found residents on given
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Licensee agreed to provide written verification that those residents still at the facility since the beginning of the change of ownership have been made aware of the change.
The verification will be submitted by the POC date of 9/9/24
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notice as required. This posed a potential risk to their persona rights
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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: 08/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2