347005215-11-2-2021-25-AS-MSEY-C8ETCA-20211103143625

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005215
Report Date: 11/02/2021
Date Signed: 11/02/2021 03:31:24 PM

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
10/20/2021 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20211020145032

FACILITY NAME:	ABUNDANT LOVE AND CARE FOR THE ELDERLY		FACILITY NUMBER:	347005215
ADMINISTRATOR:	BONITE, VIRGINIA		FACILITY TYPE:	740
ADDRESS:	2607 WALNUT AVENUE		TELEPHONE:	(916) 481-6817
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 5	DATE:	11/02/2021
		UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Virginia Bonite, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident illegally evicted from facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint the Department received on 10/20/2021. LPA met with Virginia Bonite, Administrator, and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

During the course of the investigation, LPA interviewed Administrator, (1) caregiver, (2) residents, and individual who assisted resident (R1). LPA reviewed pertinent documentation for resident (R1) including Admission Agreement, eviction letter issued on 5/1/2021, Unusual Incident/Injury report (LIC624), documentation related to move out, and other documentation.

The results of the investigation are as follows:

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20211020145032

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: ABUNDANT LOVE AND CARE FOR THE ELDERLY	FACILITY NUMBER: 347005215
	VISIT DATE: 11/02/2021

NARRATIVE

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Health and Safety Code §1569.683(a)(4) Eviction notices; reasons for eviction contents; service reads as follows: (4) The following statement: "In order to evict a resident who remains in the facility after the effective date of the eviction, the residential care facility for the elderly must file an unlawful detainer action in superior court and receive a written judgment signed by a judge. If the facility pursues the unlawful detainer action, you must be served with a summons and complaint. You have the right to contest the eviction in writing and through a hearing."

The facility issued resident a 60-day eviction notice on 5/1/2021, with an effective date of 7/1/2021; however, the eviction notice does not mention an unlawful detainer, as required, and interview with the Administrator confirmed the facility did not pursue an unlawful detainer after resident did not move out by 7/1/2021. Resident's admission agreement, dated 7/13/2020, page 10 (items #5 and 6), notes that the eviction notice must include: (item 5) "A statement that informs the resident that the licensee cannot evict a resident who remains in the facility after the effective date of the eviction unless the licensee files an unlawful detainer action in superior court and receives a written judgment signed by a judge" and (item 6) "A statement that if a licensee pursues an unlawful detainer action, the resident must be served with a summons and complaint".

Resident was sent out to the emergency room on 8/25/2021 for low oxygen and was approved by resident's home health and physician; however, the resident was not able to return to the facility when she called from the hospital. Interviews revealed that Administrator stated that she was not able to care for the resident due to having a fever but she could assist her in finding another care home. In addition, the hospital care coordinator stated she would facility back if she couldn't find placement for the resident.

Interviews confirmed that resident did not return to the facility after being sent out on 8/25/2021, was hospitalized through 8/31/2021 or longer, and resident's personal belongings were retrieved from the facility on 9/3/2021. Resident prepaid rent through 8/31/2021. The Admission Agreement discusses the facility's refund policy when a resident leaves temporarily or becomes deceased. The resident was not charged; however, for the period 9/1/2021- 9/3/2021 when her personal belongings remained at the facility.

Based on information obtained, the Department finds the allegation 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. The following deficiency was cited on 9099-D, per Title 22 Regulations, Division 6.

Exit interview. Copy of report and appeal rights provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20211020145032

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: ABUNDANT LOVE AND CARE FOR THE ELDERLY	FACILITY NUMBER: 347005215
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/02/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/16/2021 Section Cited HSC 1569.683(a)(4)	1 2 3 4 5 6 7	§1569.683 Eviction notices; reasons for eviction contents; service (4) The following statement: "In order to evict a resident who remains in the facility after the effective date of the eviction, the residential care facility for the elderly must file an unlawful detainer action in superior court and receive a written judgment signed by a judge. If the facility pursues the unlawful detainer action, you must be served with a summons and complaint. You have the right to contest the eviction in writing and through a hearing." This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator agree to read Health and Safety Code §1569.683 (copy provided during inspection on 11/2/2021) and provide a signed statment to CCLD by fax by 11/16/2021.
	8 9 10 11 12 13 14	Based on documentation reviewed and interviews conducted, the Licensee did not ensure that the eviction notice issued to resident (R1) on 5/1/2021 included all of the required elements, which posed a potential health and safety risk to resident in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021

LIC9099 (FAS) - (06/04)

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