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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005547
Report Date: 10/18/2022
Date Signed: 11/18/2022 11:43:00 AM


Document Has Been Signed on 11/18/2022 11:43 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 11/18/2022 11:16 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

NARRATIVE
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On 10/18/22 at 2:00 pm, regional office conducted an informal meeting with facility to discuss change of ownership requirements. This meeting was held virtually via Teams Meeting. Present at the meeting were Licensing Program Manager (LPM) Liza King, Licensing Program Analyst (LPA) Michael Bilger, Licensing Program Analyst (LPA) Renee Campbell, Licensee Corina Dragnea, and Perspective Applicant, Raja Bajaj.

The topic of the meeting is Change of Management for Corina Elderly Home (#347005547) and Corina Elderly Home 2 (#347005546). Liza King reported and clarified change of ownership requirements and explained that management must be added to the license and approved by the department. She also explained that due to the lease back agreement Raja Bajaj has with Corina Dragnea, if he cancels it, she will forfeit the license. Under the present agreement, Corina Dragnea continues to be responsible for the day-to-day operations of the facilities.

A citation was issued to the facility due to failure to notify the department of an intent to sell 30 days beforehand. Licensee was informed of the requirement as stated in Transferability of License, 87109(b) and Health and Safety Code 1569.191(c).

At this time, the Application Bureau has not received an application. Licensee and prospective applicant will be consulting their attorneys regarding additional issues. LPA Renee Campbell will follow up with a request for a resident roster for the facilities and request copies of eviction notices. Liza King will email management company requirements.

SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 10/18/2022 05:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833


FACILITY NAME: CORINA ELDERLY HOME
FACILITY NUMBER: 347005547

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2022
Section Cited

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87109(b)Transferability of License. (b) licensee shall notify the licensing agency ... residents... or their representatives, in writing ...at least thirty (30) days prior to the transfer ... or at the time that a bona fide offer is made, whichever period is longer. This requirement is not met as evidenced by:
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Based on observation, interviews and record review, the licensee did not notify the licening agency of intent to sell 30 days before the transfer. This poses a potential Health, Safety or Personal Rights risk to residents in care.
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Type B
10/21/2022
Section Cited

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1569.191(c) (c) No sale of the facility shall be permitted until 30 days have elapsed from the date upon which notice has been provided pursuant to paragraphs (1) and (2) of subdivision (a).

This requirement is not met as evidenced by:
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Based on observation, interviews and record review, the licensee did not notify the licensing agency of transfer 30 days before signing documents of sale. This poses a potential Health, Safety or Personal Rights risk to residents in care.
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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: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
LIC809 (FAS) - (06/04)
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