374604148-7-7-2023-08-AS-DNGN-CTJ2AC-20230707171319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604148
Report Date: 07/07/2023
Date Signed: 07/07/2023 05:13:28 PM

Document Has Been Signed on 07/07/2023 05:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	ABIGAIL'S HOMES II		FACILITY NUMBER:	374604148
ADMINISTRATOR:	GONZALEZ, BRENDA ABIGAIL		FACILITY TYPE:	735
ADDRESS:	8738 VALENCIA ST		TELEPHONE:	(619) 315-7407
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY: 4		CENSUS: 2	DATE:	07/07/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	DSP Dario Gonzalez		TIME COMPLETED:	05:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Other visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with DSP Dario Gonzalez. LPA also spoke with Administrator Raquel Garcia via phone during the visit.

Today's visit was in response to a 30-day written eviction notice, which Licensee served to Client #1 (C1) on 05/12/2023. [See LIC 811 Confidential Names List for a description of C1]. Licensee also sent a copy of this eviction notice to the CCLD San Diego Regional Office (RO).

During today’s visit, LPA performed a brief facility tour, reviewed pertinent care and administrative records, and interviewed relevant staff. As of the date of CCLD’s visit, C1 was no longer a resident of the facility. Per staff interview, C1 moved out on 06/05/2023.

According to the written eviction notice, C1 was being evicted for making “false statements” against staff. However, this is not one of the approved reasons that a client can be evicted from an ARF facility (per Regulations 80068.5 and 85068.5). Even if C1 made “false statements,” this did not violate the facility’s written “House Rules” or Admissions Agreement, which C1 signed. Licensee’s eviction notice to C1 also did not include “specific facts including the date, place, witnesses, and circumstances,” as was required.

According to staff interviews: on 06/05/2023, C1 initiated a physical altercation against Staff #1 (S1), which resulted in 911 being called and C1 being arrested. While C1 was at jail, their San Diego Regional Center case manager made arrangements to remove C1’s belongings from the facility, and for C1 to live at another facility upon their release. C1 thus effectively moved out of Abigail’s Homes II on 06/05/2023.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: ABIGAIL'S HOMES II	FACILITY NUMBER: 374604148
	VISIT DATE: 07/07/2023

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[CONTINUED FROM LIC 809]

According to regulation, a client’s failure to comply with state and/or local laws is a valid reason for a licensee to evict them. However, C1’s physical altercation with S1 was not referenced in the written eviction notice which licensee served to C1.

A preponderance of exists to show the written eviction notice, which licensee had served to C1, did not meet regulatory requirements. One (1) deficiency was cited per California Code of Regulations. A Plan of Correction was jointly developed with the licensee.

An exit interview was conducted with Gonzalez, to whom a copy of this report, the LIC809-D, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/07/2023 05:13 PM - It Cannot Be Edited

Created By: Dang Nguyen On 07/07/2023 at 04:52 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: ABIGAIL'S HOMES II	FACILITY NUMBER: 374604148
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/07/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/06/2023 Section Cited CCR 80068.5(a)	1 2 3 4 5 6 7	80068.5 Eviction Procedures: “(a) …the licensee may, upon 30 days written notice to the client, evict the client only for one or more of the following reasons: (1) Nonpayment of the rate for basic services…, (2) Failure of the client to comply with state or local law…, (3) Failure of the client to comply with general facility policies…, (4) Inability to meet the client’s needs, (5) The client refuses to comply with his/her Restricted Condition Care Plan…, (5) Change of use of the facility.”	1 2 3 4 5 6 7	Licensee agreed to contact a third-party training source (such as the Long Term Care Ombudsman) to facilitate training on Regulations 80068.5 and 85068.5 (both of which pertain to Eviction Procedures in the ARF setting). The attendees will include the administrator and any other facility supervisor/manager. Licensee agreed to E-mail LPA a copy of the completed training sign in sheet, by the POC due date.
	8 9 10 11 12 13 14	This requirement was not met, as evidenced by: Based on record review and interview, for 1 of 2 clients (C1), Licensee did not use one of the reasons allowed by law in the written eviction notice served to the client, which posed an potential 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:

Lizzette Tellez

LICENSING EVALUATOR NAME:

Dang Nguyen

LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC809 (FAS) - (06/04)

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