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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700853
Report Date: 11/22/2024
Date Signed: 11/22/2024 02:39:14 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/22/2024 and conducted by Evaluator Victoria Brown
COMPLAINT CONTROL NUMBER: 27-AS-20241122081319
FACILITY NAME:ASTORIA VISTAFACILITY NUMBER:
342700853
ADMINISTRATOR:SILAPA,MONALISAFACILITY TYPE:
740
ADDRESS:8616 BANFF VISTA DRIVETELEPHONE:
(916) 896-5140
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 6DATE:
11/22/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Monalisa SilapaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee loss control of property
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 11/22/24 at 12:30am to conduct a Case Management visit. LPA met with Monalisa Silapa, Administrator and stated the purpose of the visit.

On 8/23/24, LPA received a fax from Licensee intending to sell of the facility. On 11/14/24, LPA received an intent to rescind the sell of the facility from the Licensee. Monalisa provided a copy of the initial lease, the lease provided to the intended applicant, and the new lease to Monalisa.

Upon a review of the documents provided and emails received from the property owner. It was observed that the Licensee did not have control of property from September 1 – November 14, 2024 and the new lease began Nov 15, 2024. On 11/19/24, LPA attempted to contact the new applicant with no response. On 11/19/24, LPA contacted the property owner (left a voicemail message and sent an email).
Substantiated
Estimated Days of Completion: 30
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
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-20241122081319
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ASTORIA VISTA
FACILITY NUMBER: 342700853
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/23/2024
Section Cited
CCR
1569.191(b)
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 Sale of licensed facility; resulting issuance of new license; procedure: Except as provided in subdivision (e), the property and business shall not be transferred until the buyer qualifies for a license or provisional license within the appropriate provisions of this chapter.
This requirement was not met as evidenced by:
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Licensee shall submit in writing that all regulations in regard to change of ownership shall be followed at all times by all parties as stated in the Health and Safety Code for continued operation and licensure. Submit by fax by POC due date.
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Based on interviews and records review, Although the Licensee was present in the facility, the Licensee did not retain control of property 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: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20241122081319
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ASTORIA VISTA
FACILITY NUMBER: 342700853
VISIT DATE: 11/22/2024
NARRATIVE
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Based on the events that occurred the Licensee was not aware that they lost control of property during the application process of the new applicant.

A signed Notice of Operation in Violation of Law (NOVL) letter that was issued on 11/22/24. The (NOVL) requires one of the following: 1. Submit an application for licensure; 2. Relocate individuals who require care and supervision from the operator or operator's staff; 3. Cease operation.

The preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

As of 11/15/24, the Licensee has regained control of property. LPA provided a copy of the Guardian roster of staff during this visit.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 9099D during this visit. An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3