371881361-6-16-2023-18-AS-JESL-CT8VYH-20230628165110

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 371881361
Report Date: 06/16/2023
Date Signed: 06/16/2023 01:39:55 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/13/2023 and conducted by Evaluator Chinwe Nwogene

COMPLAINT CONTROL NUMBER: 18-AS-20230613110751

FACILITY NAME:	QUIET HILLS LIVING		FACILITY NUMBER:	371881361
ADMINISTRATOR:	BLAKE, MARY ANN		FACILITY TYPE:	740
ADDRESS:	884 GRETNA GREEN WAY		TELEPHONE:	(760) 270-2075
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92025
CAPACITY:	6	CENSUS: 6	DATE:	06/16/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Cherry Cook, Facility Operator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Licensee sold business without notifying the department.
Licensee does not have a qualified administrator.
Licensee is not operating the facility.

INVESTIGATION FINDINGS:

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On 6/16/2023, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an unannounced visit to investigate the above allegation(s). LPA met with facility operator, Cherry Cook who was informed of the purpose of the visit. At the time of visit, LPA interviewed Licensee, Rupesh Haribhai and, facility operator, Cherry Cook.
Regarding the allegation “Licensee sold business without notifying the department”, LPA interviewed Licensee who acknowledged the business was sold in March 2023 to the new facility operator Cherry Cook without notifying the department. Facility Operator acknowledged buying the business and took over the business effective 3/1/2023.
Regarding the allegation “Licensee does not have a qualified administrator”, LPA interviewed Licensee who acknowledged Cherry Cook was the acting administrator and should have notified the department of the new administrator status and updated the facility Administrator information in guardian but didn't.
Regarding the allegation “Licensee is not operating the facility”, LPA interviewed Licensee who acknowledged to no longer having control of the facility.
Based on LPA’s interviews, the preponderance of evidence standard has been met. Therefore, the above allegation(s) are found to be substantiated. California Code of Regulations (Title 22, Division & Chapter number 6) are being cited on the attached LIC 9099D). An exit interview was conducted, and a copy of this report was reviewed with and provided to Caregiver, Gladys Baldovino.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 18-AS-20230613110751

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: QUIET HILLS LIVING	FACILITY NUMBER: 371881361
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/26/2023 Section Cited CCR 87109(b)	1 2 3 4 5 6 7	Transferability of License The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least thirty (30) days prior to the transfer of the property or business.	1 2 3 4 5 6 7	Lisensee notifed the department about selling the business on 6/12/2023 via email.
	8 9 10 11 12 13 14	This requirement is not met based as evidence by interview. The licensee did not comply by selling the business on 3/1/2023 without notifying the department which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
Type B 06/26/2023 Section Cited CCR 87405(a)	1 2 3 4 5 6 7	Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator.	1 2 3 4 5 6 7	Lisensee already sold the business and no longer has control over the buiness.
	8 9 10 11 12 13 14	This requirement is not met based as evidence by interview. The licensee did not comply by not notifing the department of the new Administartor which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14

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: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20230613110751

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: QUIET HILLS LIVING	FACILITY NUMBER: 371881361
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/26/2023 Section Cited CCR 87208(a)	1 2 3 4 5 6 7	Plan of Operation Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval.	1 2 3 4 5 6 7	Licensee no longer has control of the business effective 3/1/2023.
	8 9 10 11 12 13 14	This requirement is not met based as evidence by interview. The licensee did not comply by not operating the facility which poses a potential health, safety or personal rights risk to persons 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: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

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