342700290-3-19-2021-27-AS-JMCY-BZ9TYY-20210319150931

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700290
Report Date: 03/19/2021
Date Signed: 03/19/2021 03:10:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	JASMINE-HALL I		FACILITY NUMBER:	342700290
ADMINISTRATOR:	HALL, ESTELA O		FACILITY TYPE:	735
ADDRESS:	4020 47TH STREET		TELEPHONE:	(916) 452-6244
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95820
CAPACITY:	4	CENSUS: 1	DATE:	03/19/2021
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Estela Hall, Administrator		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An teleconference was conducted today, 03/19/2021 in the Sacramento Regional Office via WebEx. Present in the meeting is Regional Managers Krystall Moore and Alycia Berryman. Licensing Program Managers Stephen Richardson, Laura Munoz and Anthony Perez. Licensing Program Analysts Victoria Brown; Tirzah Hubbard, Michael Hood and Jasmine McCrory. Present from the facility was CEO of E H Star Care Home, Inc, George Hall; Administrator, Estela Hall and Business Manager, Theo Miller, Business Manager for EH Star Care Homes Inc. The purpose of today’s meeting is to discuss the current operations of Jasmine Hall I-VIII. Topics discussed during today’s meeting were as followed: · George Hall’s role with E H Star Care Homes, Inc. · Disclosing client confidential information to outside entities · Clarify administrator’s role for each facility · Mitigation plans The Department advised that if Mr. Hall is going to be working at the facilities and be part of the corporation, Mr. Hall needs to be fingerprint cleared and associated to all facilities licensed under E H Star Care Home, Inc. (continued)

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jasmine McCrory	TELEPHONE: (916) 214-5020
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: JASMINE-HALL I	FACILITY NUMBER: 342700290
	VISIT DATE: 03/19/2021

NARRATIVE

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Upon review of the Secretary of State website, it was learned that George Hall was appointed CEO of E H STAR CARE HOMES INC. effective July 24, 2020.

The Department advised during today’s meeting that if there is a 51% change of ownership, new applications will need to be submitted for each facility.

The Department advised that should Mr. Hall be appointed as a backup Administrator; Mr. Hall will need to obtain an Administrator’s certificate.

Administrator, Estella Hall will be working with LPA Victoria Brown on Mitigation plans for Jasmine Hall(s) I-VIII.

The Administrator shall submit the following to the Department by close of business, 03/19/2021, for all licensed facilities under E H Star Care Homes, Inc to LPA Victoria Brown:
· Updated LIC308
· Updated LIC309
· LIC 500 for each facility

A copy of this report is being sent via email and will be mailed back with hard signatures.

Exit interview conducted.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jasmine McCrory	TELEPHONE: (916) 214-5020
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021

LIC809 (FAS) - (06/04)

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