374600661-2-28-2023-08-AS-DPOL-CPH26W-20230228160746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600661
Report Date: 02/28/2023
Date Signed: 02/28/2023 03:47:16 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/06/2023 and conducted by Evaluator Liliana Silveira

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230206084809

FACILITY NAME:	CALIFORNIA HOME FOR SENIORS		FACILITY NUMBER:	374600661
ADMINISTRATOR:	GLORIA S. QUILLOPE		FACILITY TYPE:	740
ADDRESS:	1061 E. BRADLEY AVENUE		TELEPHONE:	(619) 448-2870
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY:	15	CENSUS: 9	DATE:	02/28/2023
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Licensee Gloria Quillope		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Unlawful Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Liliana Silveira conducted a complaint investigation visit to deliver findings for the above-mentioned allegation. LPA Silveira met with Licensee Gloria Quillope and shared the findings.

On 02/06/23, it was alleged that Resident #1 (R1) was illegally evicted from the facility. The investigation revealed that on 02/04/23 R1 was admitted to a hospital due to health related issues. During the inpatient stay, hospital staff contacted the facility to discuss R1’s discharge plan. Facility staff refused to accept R1 back due to R1 needing a higher level of care. Facility staff did not provide R1 with a written 30-day notice of eviction. R1 was discharged to an alternate placement on 02/15/23. The Department has investigated the allegation of illegal eviction and has found that, based upon evidence gathered through interviews and record review, the preponderance of the evidence standard has been met. Therefore, this allegation is deemed substantiated. (CONTINUED ON LIC 9099C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

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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Control Number 08-AS-20230206084809

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CALIFORNIA HOME FOR SENIORS	FACILITY NUMBER: 374600661
	VISIT DATE: 02/28/2023

NARRATIVE

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Based on the evidence obtained from the complaint investigation, the allegation that there was an illegal eviction was found to be SUBSTANTIATED, as there is a preponderance of evidence to show that the allegation occurred. Pursuant to the California Code of Regulations, Title 22, Division 6, deficiency is being cited on the attached LIC 9099D.

An exit interview was conducted, plan of correction was reviewed and a copy of this report and Licensee's Rights (9058 01/16) were provided to Miriam Gavrilkina via email, whose read receipt email verifies that these documents have been received.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230206084809

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CALIFORNIA HOME FOR SENIORS	FACILITY NUMBER: 374600661
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/28/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/28/2023 Section Cited CCR 87224(a)	1 2 3 4 5 6 7	87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a) (1) through (5). Thirty (30) days written notice to the resident is required... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee refused to take resident back to the facility. Licensee will complete training through an authorized vendor on Title 22 Regulations. Licensee agreed to complete training by 03/28/23. Licensee will also follow CCR Title 22 eviction procedures when evicting a resident.
	8 9 10 11 12 13 14	Resident was not allowed back to the facility after being discharged from the hospital. A 30 day written notice was not provided to the resident.	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: Denise Powell	TELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

LIC9099 (FAS) - (06/04)

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