385600427-9-10-2024-14-AS-AMEN-D96LR4-20240916085832

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600427
Report Date: 09/10/2024
Date Signed: 09/10/2024 11:55:23 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/30/2024 and conducted by Evaluator John Calandra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20240530092104

FACILITY NAME:	VILLAGE AT HAYES VALLEY-GROVE BUILDING, THE		FACILITY NUMBER:	385600427
ADMINISTRATOR:	ELOIS THOMAS		FACILITY TYPE:	740
ADDRESS:	601 LAGUNA STREET		TELEPHONE:	(415) 318-8670
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94102
CAPACITY:	47	CENSUS:	DATE:	09/10/2024
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:			TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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LPA John Calandra and LPM Andrea Medlin concluded this complaint today; original complaint investigation visit was conducted on 6/7/2024 by LPA Jaime Vado. LPA and LPM called facility representative to go over allegation findings on 9/5/2024 and left a voicemail message asking for a return call. As of today, September 10, 2024, Reporting Party has not returned call. Regarding allegation regarding a violation of residents being illegally evicted, it was determined that facility notified some residents in late May 2024 that the building was sold and residents were told they had to leave. Some residents were given a 30 day notice and other residents were given a 60 day notice. The facility is required to give a 60 day notice to evict residents due to a change of use of facility, in this case ceasing operation as a community care facility.

Based on the investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. The deficiencies cited on the following page is in violation of the California Code of Regulations, Title 22, Division 6, Chapter 8. Failure to correct said deficiencies may result in additional civil penalties.

This report was provided to facility by email and certified return receipt mail (since facility is closed and vacant) and a copy of this report must be made available for public review upon request.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: John Calandra	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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 14-AS-20240530092104

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: VILLAGE AT HAYES VALLEY-GROVE BUILDING, THE	FACILITY NUMBER: 385600427
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/10/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/10/2024 Section Cited CCR 87224(a)(5)	1 2 3 4 5 6 7	87224(a)(5)Eviction Procedures: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 except as otherwise specified in paragraph. (5) Change of use of the facility.(A) The licensee may, upon no less than sixty (60) days written notice, evict a resident due to change of use of the facility.	1 2 3 4 5 6 7	Deficiency closed as of 9/10/2024 as facility has ceased to operate as a community care facility.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by LPA obtained eviction notices that only provided some residents 30 days notice rather than the required 60 days notice residents. Facility has ceased operation as a community care facility.	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: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: John Calandra	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC9099 (FAS) - (06/04)

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