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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701028
Report Date: 04/21/2022
Date Signed: 04/21/2022 03:35:00 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/18/2021 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 25-AS-20211118152214
FACILITY NAME:MKS QUALITY CARE LLCFACILITY NUMBER:
342701028
ADMINISTRATOR:LEE, KEVINFACILITY TYPE:
740
ADDRESS:317 NATOMA ST.TELEPHONE:
(916) 831-7972
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:15CENSUS: 8DATE:
04/21/2022
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Tatleen LewisTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Licensee did not provide a refund according to admission agreement terms.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)s Kerry Hiratsuka and Lavinia Muscan, arrived at the facility unannounced on 04/21/2022, to conduct a Complaint Investigation Visit. LPA conducted COVID-19 Precautionary prescreening, and wore surgical masks while at facility. LPA was screened by Caregiver.

The department investigated the allegation "Licensee did not provide a refund according to admission agreement terms." The department interviewed staff and reviewed resident admission agreement. Per the CA health and safety code a faclity may charge a pre-admission fee. There is a refund schedule for the pre-admission fee regarding how long a resident stays. Manager Maria Cucicea, admitted that she did not refund the pre-admission fee per the CA health and safety code.

Based on the above, the allegation is substantiated. The following deficiencies were cited on 909-D, per Title 22 Regulations, Division 6. Appeal rights left with facility representative.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
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 2
Control Number 25-AS-20211118152214
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: MKS QUALITY CARE LLC
FACILITY NUMBER: 342701028
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2022
Section Cited
HSC
1569.651(i)(1)
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Preadmission fee or deposit for elderly at residential care facilities; written statement describing costs and stating whether fee is refundable; conditions for refund; refund rate schedules. Notwithstanding subdivision (g), if a resident is evicted by a facility pursuant to subdivision (a) of Section 1569.682, the resident or the resident's legal
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By 05/20/2022, the licensee shall submit in writing how they are going to ensure they are going to follow the refund policy per the health and safety code regarding pre-admission fees.
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representative shall be entitled to a refund of preadmission fees in excess of five hundred dollars ($500) in accordance with all the following.
This was not evidenced by: Manager admitted she did not refund per the schedule. This is a potential risk to resident
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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: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
LIC9099 (FAS) - (06/04)
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