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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700850
Report Date: 11/02/2023
Date Signed: 11/02/2023 12:41:12 PM

Substantiated


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
10/27/2023 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20231027161338
FACILITY NAME:TWIN CITIES BOARD & CARE HOMEFACILITY NUMBER:
342700850
ADMINISTRATOR:LINDA MUSTINFACILITY TYPE:
735
ADDRESS:11098 TWIN CITIES ROADTELEPHONE:
(209) 745-4380
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY:15CENSUS: 15DATE:
11/02/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Linda Mustin TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Licensee evicted resident without sufficient cause.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio and LPA Victoria Brown arrived unannounced to the facility to conduct a 10-Day Visit and complaint investigation. LPAs were met by facility staff Kathy, and explained the purpose of the visit. LPAs were later met by Licensee/Administrator Linda Mustin.

LPA conducted interviews. According to an outside agency (OA1), OA1 stated the letter was a hand written letter and signed by Administrator Linda. The letter stated the reason for eviction were foul language, not making the bed, and breaking house rules. Based on OA1's observation, the eviction was considered illegal.
LPA interview Resident 1 (R1). R1 stated an eviction letter was given to R1 but the letter was withdrawn.

According to an interview with licensee/Administrator Linda, Linda gave the eviction letter based on specific incidents that occured with Resident 1 and Resident 2; however, Administrator Linda and staff did not document any of the incidents.
Continues on LIC 9099 -C..
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
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 3
Control Number 27-AS-20231027161338
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: TWIN CITIES BOARD & CARE HOME
FACILITY NUMBER: 342700850
VISIT DATE: 11/02/2023
NARRATIVE
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Continued from LIC 9099...

According to Administrator Linda, she only included a few of the reasons for the eviction to protect the resident. Administrator stated the case manager and family are aware of the incidents that are alleged to have occurred. According to Administrator Linda, she withdrew the eviction letter after speaking to the Long Term Care Ombudsman for Sacramento.

During the investigation, LPAs provided technical assistance on daily documentation, incident reports, and house rules. LPAs obtained copies of R1's file, the house rules, and pictures of the facility for future reference.

Based on interviews, record review, and observations, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 6) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided.  An exit interview was conducted, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 27-AS-20231027161338
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: TWIN CITIES BOARD & CARE HOME
FACILITY NUMBER: 342700850
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/03/2023
Section Cited
CCR
85068.5(a)
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85068.5 Eviction Procedures (a) The licensee shall be permitted to evict a client by serving the client with a 30-day written notice to quit for any of the following reasons:... This requirement was not met as evidenced by:
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Licensee stated Title 22, Section 85068.5 will be reviewed to its entirety. Licensee to send a statement acknowledging understanding of Eviction Procedures by POC due date of 11/03/2023. By 11/30/23, licensee will submit the facility's plan to handle evictions in the future and updated copy of House Rules.
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Based on observations, records review, and interviews, the licensee did not ensure R1's eviction letter was provided in accordance with Title 22 regulations, which poses an immediate health, safety, and personal rights risk to residents in care.
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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.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3