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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001880
Report Date: 06/19/2024
Date Signed: 06/19/2024 12:15:12 PM

Document Has Been Signed on 06/19/2024 12:15 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ED DAVID CARE HOME #2FACILITY NUMBER:
347001880
ADMINISTRATOR/
DIRECTOR:		DIAMOND ANDERSONFACILITY TYPE:
735
ADDRESS:7200 LARCHMONT DRIVETELEPHONE:
(916) 331-4775
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 6CENSUS: 6DATE:
06/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Staff, Mary Anne BeasleyTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 06/19/24,Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility to conduct a Case Management visit regarding an incident that occurred on 05/15/24. LPA met with staff,S1,Mary Anne Beasley and explained the reason for the visit. LPA and S1 spoke with Administrator, Diamond Anderson who stated that they were not able to come in to assist with today's visit and gave permission to S1 to conduct today's visit with LPA and sign the report as well.

A case management visit is conducted today to follow up on an incident that occurred at the facility on
May 15, 2024.

The facility reported to the Department that an unknown individual broke into Ed David Care Home #2 , 347001880, 7200 Larchmont Drive, North Highlands, CA ,95660. Based on the investigation, an unknown male broke into the facility and was able to access and obtain all resident’s P&I funds which were located in an office in a safe. The facility took immediate action and contacted local law enforcement, conducted an internal investigation as well as file a claim to obtain all resident’s funds back. At the current time, the facility is using facility funds for resident’s P&I until the claim is processed, approved and the monies have been reimbursed to the residents. Based on information obtained, the licensee keeps all resident’s P&I funds for all residents who reside at all the homes licensed by the licensee at Ed David #2.

Although the facility took appropriate actions in safeguarding resident’s funds, based on Title 22 regulations, a facility is not to commingle residents funds with another licensed facility, regardless of the licensee.

Based on this information, Citations are being issued today and are listed on the attached LIC809-D.
Appeal Rights and copy of the report has been provided to S1.



SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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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Document Has Been Signed on 06/19/2024 12:15 PM - It Cannot Be Edited


Created By: Talwinder Bains On 06/19/2024 at 11:47 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ED DAVID CARE HOME #2
FACILITY NUMBER: 347001880

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2024
Section Cited
CCR
80026(g)

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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents-(g) -The licensee shall not commingle cash resources and valuables of clients with those of another community care facility of a different license number regardless of joint ownership.....this requirement is not met as evidenced by;
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The facility immediate cease from commingling funds between the licensees licensed homes. The facility shall submit a plan to the Department on how the licensee will ensure that resident’s P&I funds will be present, safeguarded and available in the facility the resident resides at. POC shall be submitted to the Department by 07/03/24.
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Based on information gathered, facility did not safeguard's residents P&I funds and commingle thier cash resources and valuables as funds were stolen by unknown person on 05/15/24 which poses a potential risks to residents health and safety .
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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:Laura Munoz
LICENSING EVALUATOR NAME:Talwinder Bains
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2024


LIC809 (FAS) - (06/04)
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