392700332-2-17-2021-27-AS-AMAZ-BYBRDM-20210217115611

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 392700332
Report Date: 02/10/2021
Date Signed: 02/17/2021 11:58:13 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME:	A PLACE CALLED HOME II		FACILITY NUMBER:	392700332
ADMINISTRATOR:	SIMONE A PIERRE JEROME		FACILITY TYPE:	740
ADDRESS:	25820 MAGNOLIA AVE		TELEPHONE:	(209) 986-3949
CITY:	ESCALON	STATE: CA	ZIP CODE:	95320
CAPACITY:	11	CENSUS: 10	DATE:	02/10/2021
TYPE OF VISIT:	Case Management - Legal/Non-compliance	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Lesley Pinola and Ryta Martinez		TIME COMPLETED:	03:00 PM

NARRATIVE

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On 2-10-21, Regional Manager (RM) Krystall Moore, Licensing Program Manager (LPM) Stephenie Doub, and Licensing Program Analyst (LPA) Avelina Martinez conducted an Office Visit via Microsoft Teams with Lesley Pinola and Ryta Martinez in order to discuss the Decision and Order that was adopted on January 29, 2021. A copy of the Decision and Order, Proposed Decision, Notice of Time Limits for Reconsideration, and Notice of Exclusion was served by the Department on January 29, 2021 to relevant parties.

Per Decision and Order, on January 29, 2021, the facility will no longer have a license to operate and it shall be closed. Lesley Pinola has "failed to demonstrate knowledge of and ability to conform to the applicable laws, rules and regulations. Lesley Pinola is prohibited "from employment in, presence in, or contact with clients of any facility licensed by the Department." "Lesley Pinola's administrator certificate is deemed forfeited based on revocation of her facility license and the imposed exclusion order."

Items discussed during the meeting were:

1. LPA Martinez read the stipulation, and waiver, and order to Lesley Pinola and Ryta Martinez .
2. Health and Safety visits will be conducted until the change of ownership process has been completed.
3. Change of Ownership applications have been received.
4. Closure will be stayed for 90 days from 1/29/2021 due to pending facility sale.
5. Should application of new licensee be denied, an additional 30 day stay may be requested to assist residents in transferring to an appropriate licensed facility.

Continued...

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (915) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021

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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: A PLACE CALLED HOME II	FACILITY NUMBER: 392700332
	VISIT DATE: 02/10/2021

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The facility has stated they will do the following to achieve continued and substantial compliance:

1. On today's date, LPA advised Lesley Pinola to continue updating the Department regarding the status of resident relocation.
2. Submit Facility Roster.
3. Facility will assist with transitioning of new licensee and/or proper transfer of residents as stipulated.
4. Return a signed 12/07/2020 report and return 12/07/2020 civil penalty documentation.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. An exit interview was conducted with Lesley Pinola via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (915) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021

LIC809 (FAS) - (06/04)

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