372004630-9-13-2023-18-AS-RLAY-CW7PF9-20231001111623

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 372004630
Report Date: 09/13/2023
Date Signed: 09/13/2023 09:32:47 AM

Unfounded

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
05/25/2023 and conducted by Evaluator Tricia Danielson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230525141314

FACILITY NAME:	COUNTRY CLUB GUEST HOME		FACILITY NUMBER:	372004630
ADMINISTRATOR:	RAMIREZ, JULIE		FACILITY TYPE:	740
ADDRESS:	25533 RUA MICHELLE		TELEPHONE:	(760) 747-0957
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92026
CAPACITY:	30	CENSUS: 23	DATE:	09/13/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kevin Ramirez, Co-Administrator		TIME COMPLETED:	09:15 AM

ALLEGATION(S):

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Illegal Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced at the facility to conclude an investigation into the allegation listed above. LPA met with Co-Administrator (Co-AD) Kevin Ramirez and explained the purpose of the visit.
Regarding the allegation "Illegal eviction", it was alleged that due to nonpayment of rent, Resident #1(R1) was given a handwritten notice of eviction without 30 days’ notice. Interview with Licensee Julie Ramirez revealed R1 was provided a written 30-day notice to evict on 4/20/2023 for nonpayment of rent in its entirety for the months November 2022, January 2023, February 2023, March 2023, and April 2023 which was in violation of the terms of the admission agreement. Review of R1's admission agreement revealed R1 agreed to the terms of the admission agreement as evidenced by thier signature. Records reviewed also indicated a copy of R1's 30-day eviction notice was also emailed to R1's care coordinator on 4/20/2023. This agency has investigated the complaint alleging "Illegal eviction". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names list.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -24-0313
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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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