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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005340
Report Date: 11/22/2023
Date Signed: 11/30/2023 05:19:23 PM


Document Has Been Signed on 11/30/2023 05:19 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:MCGREGOR HOME 5FACILITY NUMBER:
347005340
ADMINISTRATOR:LIZA SEGUBANFACILITY TYPE:
740
ADDRESS:3906 APPLE BLOSSOM WAYTELEPHONE:
(916) 900-4829
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 4DATE:
11/22/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Heidi Arana, LicenseeTIME COMPLETED:
11:30 AM
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A meeting was conducted at 10:30am on November 22, 2023, with Sacramento North Regional Office (RO) via Microsoft Teams. Present in the meeting were Licensee, Heidi Arana, Maria So, Licensing Program Manager (LPM), Maribeth Senty, LPM Troy Ordonez, and Licensing Program Analyst (LPA), Angela Hood.

The purpose of the meeting was to discuss the pending change of ownership (CHOW). The Department had concerns regarding the time span for the CHOW, as the CHOW was due to a decision and order that became effective on 3/15/23.

During today's meeting, the RO was informed that, according to the licensee's agreement with the applicant, the expectation was that the application was going to be submitted to the Centralized Application Bureau (CAB) by April 2023. The licensee indicated that they were recently made aware that the application was not submitted until June 2023 and that the applicant they were working with was not on the application. The Licensee indicated that they did not agree to the application being completed by another party other than the applicant they were working with.

The Licensee stated that the applicant was added to the lease in May 2023 to take over the rent and utility payments, and that they were late on all payments and didn't pay any bills in June 2023. The licensee stated that the landlord wanted to issue an eviction notice to the applicant and the applicant was removed from the lease in August 2023. The licensee stated that they were able to avoid the eviction notice being issued to the applicant by taking over the lease agreement in September 2023, which would ensure payments are made timely. The licensee also paid any outstanding payments due.


**********************************************Continued on LIC809-C************************************************
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela HoodTELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MCGREGOR HOME 5
FACILITY NUMBER: 347005340
VISIT DATE: 11/22/2023
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The licensee stated that they terminated their agreement with the applicant in August 2023. They have a new applicant that is ready to submit documentation to CAB once the current applicant is either denied or withdrawn from the application process. The licensee is aware that the current applicant has sought legal counsel regarding their application and that they have missing documentation to be submitted to CAB. The licensee is also meeting with their attorney to discuss the application concerns.

The facility currently has 2 residents receiving hospice care. The facility care staff have not changed during the application process as the applicant retained the previous staff. The current Administrator is Liza Seguban since September 2023. A follow-up meeting will be held with the licensee.

No deficiencies were cited during today’s meeting.

An exit interview was conducted and copy of this report was provided via email with request for return with signature.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela HoodTELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC809 (FAS) - (06/04)
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