342700067-2-28-2022-27-AS-KHOS-CC4PM9-20220301102559

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700067
Report Date: 02/17/2022
Date Signed: 02/28/2022 12:10:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/25/2022 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20220125111321

FACILITY NAME:	HOSPITALITY HOUSE		FACILITY NUMBER:	342700067
ADMINISTRATOR:	LORRAINE PADILLA		FACILITY TYPE:	740
ADDRESS:	5400 KIERNAN AVENUE		TELEPHONE:	(209) 543-9275
CITY:	SALIDA	STATE: CA	ZIP CODE:	95368
CAPACITY:	80	CENSUS: 47	DATE:	02/17/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator Lorraine Padilla		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Rates are being increased without a description of additional costs.
Residents are not being changed in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarah Hurt conducted and unannounced visit to the facility on 02/17/2022 at 10:00 a.m. to investigate a complaint on the above allegations. LPA met with Administrator Lorraine Padilla and explained the purpose of today’s visit.

Regarding the allegation rates are being increased without a description of additional costs. Based on records reviewed the facility did send out "60 day notice rent increase with new ownership and contract." The letter states the reasoning for the rate increase and states if residents agree to the increase they will sign a new contract. The letter states if they do not agree to the rate increase residents need to take proper steps in giving a 30 day notice to vacate their apartments. Resident 1's only income is SSI and his letter documents his rent will be increased from $1,566.00 to $3,450.00. Resident 1 should not be obligated to pay more than the SSI rate. Therefore this complaint is SUBSTANTIATED.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

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 5

Control Number 27-AS-20220125111321

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: HOSPITALITY HOUSE	FACILITY NUMBER: 342700067
	VISIT DATE: 02/17/2022

NARRATIVE

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Regarding the allegations Facility is not providing incontinent care. Based on a previous complaint LPA interviewed 4 facility residents all stated they have waited 30 minutes or more to have their incontinent needs met. Therefore, this allegation is SUBSTANTIATED. No further citations will be issued during this visit for this allegation as the facility was cited on 01/05/2022 complaint # 27-AS-20210824100818 for managed incontinence regarding a similar allegation.

The following deficiency was cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Lorraine Padilla and a copy of this report along with appeal rights was provided.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 27-AS-20220125111321

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: HOSPITALITY HOUSE	FACILITY NUMBER: 342700067
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/17/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/25/2022 Section Cited CCR 87464(e)	1 2 3 4 5 6 7	87464 Basic Services.(e) If the resident is an SSI/SSP recipient, then the basic services shall be provided and/or made available at the basic rate at no additional charge to the resident. The following requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Licensee will send plan to LPA by 02/25/2022 detailing their plan on housing SSI residents currently in their care.
	8 9 10 11 12 13 14	Based on records reviewed the Licensee gave SSI residents notice of rate increases from $1,566 to $3,450. The new rate of $3,450 being well above the SSI rate which poses a potentiol health, safety,or personal rights risk to residents in care.	8 9 10 11 12 13 14
	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: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/25/2022 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20220125111321

FACILITY NAME:	HOSPITALITY HOUSE		FACILITY NUMBER:	342700067
ADMINISTRATOR:	LORRAINE PADILLA		FACILITY TYPE:	740
ADDRESS:	5400 KIERNAN AVENUE		TELEPHONE:	(209) 543-9275
CITY:	SALIDA	STATE: CA	ZIP CODE:	95368
CAPACITY:	80	CENSUS: 47	DATE:	02/17/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator Lorraine Padilla		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility is short staffed.
Residents are not provided comfortable furniture while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarah Hurt conducted and unannounced visit to the facility on 02/17/2022 at 10:00 a.m. to investigate a complaint on the above allegations. LPA met with Administrator Lorraine Padilla and explained the purpose of today’s visit.

Regarding the allegation facility is short staffed. Based on records reviewed the facility is sufficiently staffed. There is 1 med tech, 2 memory care caregivers, 1 caregiver dedicated to caring for COVID positive residents. and 1 caregiver in assisted living. The facility schedule also reflects 2 caregivers in assisted living several days a week, and another floating caregiver to assist with any extra resident calls. Therefore, the allegation is deemed UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 27-AS-20220125111321

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: HOSPITALITY HOUSE	FACILITY NUMBER: 342700067
	VISIT DATE: 02/17/2022

NARRATIVE

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Regarding the allegation residents are not provided comfortable furniture while in care. LPA observed several couches, and chairs in the facility living area in both assisted living and memory care. LPA observed plenty of tables and chairs in the facility dining area. The dining chairs are wood for easy cleaning and sanitizing. LPA observed resident bedrooms to be complete with bed, dresser, and chair. Therefore, the allegation is deemed UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Per title 22 no deficiencies being cited during this visit. Exit interview was conducted with Administrator Lorraine Padilla and a copy of this report was provided.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 5