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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700814
Report Date: 08/22/2022
Date Signed: 08/22/2022 11:52:19 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/08/2022 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20220608114605
FACILITY NAME:A LOVING PLACE FOR YOUR PARENTSFACILITY NUMBER:
392700814
ADMINISTRATOR:DENISE ORDONEZFACILITY TYPE:
740
ADDRESS:488 POELSTRA COURTTELEPHONE:
(714) 948-0381
CITY:RIPONSTATE: CAZIP CODE:
95366
CAPACITY:0CENSUS: 0DATE:
08/22/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:ArreguinTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Licensee requests advance payment for rent
INVESTIGATION FINDINGS:
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On 8/22/22 at approximately 10:30am Licensing Program Analyst (LPA) Maja Jensen arrived at A Loving Place located at 2800 Catala Way, Modesto unannounced to deliver findings for the complaint investigation related to the above listed allegation. LPA delivered findings at A Loving Place as the facility for which the complaint was filed against is now closed. LPA Jensen met with Administrator Martha Arreguin and explained the purpose of today's visit.

During the course of the investigation LPA Jensen conducted interviews and reviewed documentation including but not limited to resident files and financial records. LPA Jensen reviewed a canceled check issued by the responsible party for resident 1 (R1) that was issued in September of 2021 prior to the resident's placement at the facility. The amount of the check was 3 times the monthly rate for rent as indicated in the rental agreement and was issued to cover rent in advance for October, November and December of 2021.
Continued on LIC 9099C...

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 27-AS-20220608114605
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
VISIT DATE: 08/22/2022
NARRATIVE
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Based on the financial records reviewed and interviews conducted the preponderance of evidence standard has been met. This allegation has been SUBSTANTIATED.

Deficiencies are being cited on this day from the California Code of Regulations, Title 22, Division 6.

An exit interview was conducted with Administrator Martha Arreguin and a copy of this report and appeal rights were given.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20220608114605
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 08/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2022
Section Cited
CCR
87507(f)
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87507 Admission Agreements
(f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met as evidenced by:
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The Licensee relinquished the facility license in July of 2022 therefore no Plan of Correction is required.
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The admission agreement is written for a contractual obligation of the resident to make monthly payments without a requirement for advance payment beyond the current month however advance payment for 3 months of future rent was collected.
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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: 08/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/08/2022 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20220608114605

FACILITY NAME:A LOVING PLACE FOR YOUR PARENTSFACILITY NUMBER:
392700814
ADMINISTRATOR:DENISE ORDONEZFACILITY TYPE:
740
ADDRESS:488 POELSTRA COURTTELEPHONE:
(714) 948-0381
CITY:RIPONSTATE: CAZIP CODE:
95366
CAPACITY:0CENSUS: 0DATE:
08/22/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Martha ArreguinTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
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9
Licensee did not provide refunds upon death of resident
INVESTIGATION FINDINGS:
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On 8/22/22 at approximately 10:30am Licensing Program Analyst (LPA) Maja Jensen arrived at A Loving Place located at 2800 Catala Way, Modesto unannounced to deliver findings for the complaint investigation related to the above listed allegation. LPA delivered findings at A Loving Place as the facility for which the complaint was filed agfainst is now closed. LPA Jensen met with Administrator Martha Arreguin and explained the purpose of today's visit.

During the course of the investigation an audit was initiated in order to allow the Department to review financial records that could either prove or disprove the allegation listed above. The Licensee failed to comply with all audit requests for documentation and initiated a forfeiture of license, as such this allegation is UNSUBSTANTIATED. Although the allegation may have happened, the preponderance of evidence standard has not been met due to a lack of evidence.

An exit interview was conducted and a copy of this report given.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4