347005361-3-4-2024-27-AS-KHOS-D39MUM-20240311095522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005361
Report Date: 03/04/2024
Date Signed: 03/04/2024 09:45:54 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/23/2024 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240223134826

FACILITY NAME:	SUMMERSET ASSISTED LIVING		FACILITY NUMBER:	347005361
ADMINISTRATOR:	ELISA WEATHERS		FACILITY TYPE:	740
ADDRESS:	2341 VEHICLE DR		TELEPHONE:	(916) 330-1300
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95670
CAPACITY:	135	CENSUS: 86	DATE:	03/04/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Danielle Barry		TIME COMPLETED:	09:50 AM

ALLEGATION(S):

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Resident received unlawful eviction notice

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced along with ombudsman Suhair Siraj to open this complaint investigation. LPA Moleski met with Danielle Barry and explained the purpose of the visit.

LPA Moleski reviewed a copy of an eviction notice served to a resident (R1) on February 9, 2024. According to the notice, R1 was being evicted "due to inappropriate behavior that occurred in the facility." No further description of the alleged behavior was provided. The notice does not include, as required by 22 CCR Section 87224(d)(1)(B-D), specific facts to permit determination of the date, place, witnesses and circumstances concerning the reasons relied upon for the eviction, nor does it contain resources available to assist in identifying alternative housing and care options, nor does it include a statement informing residents of their right to file a complaint with the licensing agency, nor does it contain contact information for the licensing agency or for the ombudsman's office, nor does it include the statements required per HSC Section 1569.683(a)(4) regarding unlawful detainers and legal rights to contest the unlawful detainer action in writing and through a hearing. [continued on 9099-C]

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

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 27-AS-20240223134826

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUMMERSET ASSISTED LIVING	FACILITY NUMBER: 347005361
	VISIT DATE: 03/04/2024

NARRATIVE

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The department has determined the following as it relates to the allegation that a resident was served an unlawful eviction notice:

Based on record review, this allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met.

This facility is being cited per 22 CCR Section 87224(d). An exit interview was held with Barry. Appeal rights and a copy of this report was left with Barry.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20240223134826

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUMMERSET ASSISTED LIVING	FACILITY NUMBER: 347005361
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/04/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/05/2024 Section Cited CCR 87224(d)	1 2 3 4 5 6 7	"(d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons." This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to rescind the eviction notice, and to send notice of having rescinded the notice to the resident and/or resident's responsible parties by the POC due date.
	8 9 10 11 12 13 14	Based on record review, R1 was served an unlawful eviction notice, which poses a potential health, safety, and/or personal rights risk.	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: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

LIC9099 (FAS) - (06/04)

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