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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701028
Report Date: 05/11/2022
Date Signed: 05/11/2022 04:41:17 PM

Unsubstantiated


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
02/28/2022 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 25-AS-20220228145015
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: DATE:
05/11/2022
UNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Tatleen LewisTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Licensee failed to report as required.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)s Kerry Hiratsuka and Lavinia Muscan, arrived at the facility unannounced on 05/11/2022, 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 failed to report as required.” The issue is whether the facility was required to notify Community Care Licensing Division (CCLD) when the licensee received an eviction notice. After reviewing the regulations, there is no specific regulation regarding if the licensee is required to notify CCLD that the licensee received an eviction notice from the landlord for reasons not related to CA Health and Safety Code 1569.686.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
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-20220228145015
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
VISIT DATE: 05/11/2022
NARRATIVE
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CA Health and Safety Code 1569.686 Licensee notification of specified events; department initiation of compliance plan, noncompliance conference, or other appropriate action; penalties; exception states: (a) A licensee shall notify the department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, within two business days, and shall notify all applicants for potential residence, and, if applicable, their legal representatives, prior to admission, of any of the following events, or knowledge of the event:
(1) A notice of default, notice of trustee's sale, or any other indication of foreclosure is issued on the property.
(2) An unlawful detainer action is initiated against the licensee.
(3) The licensee files for bankruptcy.
(4) The licensee receives a written notice of default of payment of rent described in Section 1161 of the Code of Civil Procedure.
(5) A utility company has sent a notice of intent to terminate electricity, gas, or water service on the property within not more than 15 days of the notice.

CCLD has not been able to determine if the notice given to the licensee by the landlord meets the criteria above. Because of this the allegation cannot be proved or disproved if the licensee was obligated to notify CCLD.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2