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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700814
Report Date: 07/21/2022
Date Signed: 07/21/2022 11:30:18 AM


Document Has Been Signed on 07/21/2022 11:30 AM - 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:A LOVING PLACE FOR YOUR PARENTSFACILITY NUMBER:
392700814
ADMINISTRATOR:MARTHA ARREGUINFACILITY TYPE:
740
ADDRESS:488 POELSTRA COURTTELEPHONE:
(714) 948-0381
CITY:RIPONSTATE: CAZIP CODE:
95366
CAPACITY:0CENSUS: 5DATE:
07/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Martha ArreguinTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Maja Jensen arrived at the facility and met with Administrator Martha Arreguin to deliver investigation findings on the case management from 6/2/22 related to a personal rights violation. This investigation was conducted by the Department and consisted of site interviews with the facility administrator, staff and residents. Law Enforcement reports, staff files, employee roster, employee schedules and resident records were obtained and reviewed.

This investigation concluded that resident 1 (R1) made an allegation of witnessing a sexual assault of resident 2 (R2) by a staff member at the facility. The Police Department conducted an investigation and found sufficient evidence to issue 3 felony and one misdemeanor charge against the alleged perpetrator. The Police Department’s investigation consisted of interviews with R1, R2, the responsible party for R2, resident 3 (R3), the Licensee Nataley Martinez, the alleged perpetrator, and staff 1 (S1). According to law enforcement reports, the alleged perpetrator confessed to the sexual assault. Based on the records reviewed, the law enforcement reports and the pending charges against the perpetrator the preponderance of evidence standard has been met.

The following deficiencies were observed (see LIC 9099-D) and cited from the California Code of Regulations, Title 22. A civil penalty in the amount of $500 is being issued on today's visit due to the violation resulting in sexual abuse of a resident. Failure to correct the deficiency may result in additional civil penalties. At the time of the complaint visit, the issuance of an Enhanced Civil Penalty was still being determined and the licensee was informed that a civil penalty might be assessed based on Health and Safety Code § 1569.49 Appeal rights were provided. Exit interview conducted with Martha Arreguin. Copy of the report was provided to the Administrator and appeal rights were received.

SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2022
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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Document Has Been Signed on 07/21/2022 11:30 AM - It Cannot Be Edited

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 LOVING PLACE FOR YOUR PARENTS
FACILITY NUMBER: 392700814

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2022
Section Cited

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(a) ...residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: ...To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evidenced by:
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Based on the law enforcement reports including the perpetrator's confession, interviews with the witness, victim, staff, residents and record reviews the resident was subjected to a sexual assault posing an immediate health and safety risk.
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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: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2022
LIC809 (FAS) - (06/04)
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