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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000389
Report Date: 06/08/2022
Date Signed: 07/22/2022 02:42:13 PM


Document Has Been Signed on 07/22/2022 02:42 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 06/22/2022 09:39 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

NARRATIVE
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*Note: This document has been amended to add the additional information below, please see Line 23*
An office meeting was held on 06/08/2022 at 9:00 AM on a Microsoft Teams Meeting video conferencing system review the stipulation adopted on 6/1/2022 and the next steps. This Stipulation shall be posted in a conspicuous place at the facility for the duration of the probationary period.

The following were in attendance: Regional Manager Alycia Berryman, Licensing Program Manager Maribeth Senty, Licensing Program Analyst Cassie Yang, Representatives of WG El Camino Gardens SH LP; Atria Management CO, Administrators of WG El Camino Gardens SH LP; Atria Management CO: Jason Thomas, Danny McCoy, Jen Johnson, Dana Stanel and Kimberly Hagen.

Alycia Berryman discussed the purpose and elements of this type of meeting. The Stipulation was reviewed with Representatives, Administrators, and Licensees who expressed their understanding.

Items discussed at the meeting included, but not limited to:
Stipulation contents
· Findings
· Revocation of License-Stayed with Probation
· Limitations and conditions
· Monitoring Penalty-Rescinded
· Future Application for License, Registration, Certification or Approval
· Licensure, Certification or Approval; Application Denial, Tolling of Probationary Period
· Completion of Probation
*Discussed the licensee’s ability to seek an early termination of probation after one year*x
· Violation of Stipulation Term
· Monitoring Fee
· Department's Authority
· Waiver of Hearing Rights; Waiver of Appeal/Modification Rights/Waiver of Claims
· Severable terms
· Public Records
· Signatures
· Counterparts
· Effective Date: (6/1/2022 – 6/1/2024)
· No Oral Modification
· Representations RE. Corporate Licensee

The Licensees/Respondents/Representatives stated they would abide by the following:
· Abide by the contents/terms of the Stipulation (submit all documents timely)
· Operate the facility in substantial compliance with the regulations and statues governing the operation of a residential care facility for the elderly.

CCLD will do the following:
· Increase monitoring

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations cited during this visit. An exit interview was conducted, and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.

COMMENTS-LICENSE
PROBATION PERIOD 06/01/2022 TO 06/01/2024 FACILITY LICENSED FOR 325 NON-AMBULATORY RESIDENTS, 20 OF WHOM MAY RECEIVE HOSPICE SERVICES.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022
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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