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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701008
Report Date: 04/29/2022
Date Signed: 04/29/2022 10:21:45 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
02/24/2022 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20220224125758
FACILITY NAME:PLACE CALLED HOMEFACILITY NUMBER:
392701008
ADMINISTRATOR:VARGAS, BRANDIFACILITY TYPE:
740
ADDRESS:25820 MAGNOLIA AVETELEPHONE:
(714) 948-0381
CITY:ESCALONSTATE: CAZIP CODE:
95320
CAPACITY:0CENSUS: DATE:
04/29/2022
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility is not paying bills
INVESTIGATION FINDINGS:
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On 4/29/22 Licensing Program Analyst (LPA) Maja Jensen and Licensing Program Manager (LPM) Liza King conducted an announced visit to complete and deliver findings for a complaint investigation received 2/24/2022. LPA and LPM met with Licensee Nataley Martinez and discussed the conclusion for the complaint and the finding.

During the investigation , LPA reviewed documents including but not limited to a Notice to Quit, California Association of Realtors, Form NTQ, financial records related to payment obligations for propane and refunds due. LPA and LPM also conducted interviews with Party 1 (P1) and Staff 1 (S1).

It was determined during the course of the investigation that a 3 day pay or quit notice was served on 02/16/22 with payment due on 02/20/22. LPA observed posted on the facility door on 03/18/2022 the Notice to Quit signed on 03/14/22 by the owner/agent which specifies nonpayment as one of the three reasons for eviction.
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: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
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 3
Control Number 27-AS-20220224125758
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: PLACE CALLED HOME
FACILITY NUMBER: 392701008
VISIT DATE: 04/29/2022
NARRATIVE
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This document also specified that on 3/9/22 the property was abandoned. Interviews concluded that rental payments were not made timely. Additionally, complaint number 27-AS-20220317164418 reported on 3/17/22 with an allegation of refund owed but not paid was substantiated.

The allegation of facility is not paying bills is SUBSTANTIATED meaning there was a preponderance of evidence to prove that the allegation occurred as reported. The following deficiencies were cited on 9099-D per Title 22, Division 6 of the California Code of Regulations.

An exit interview was conducted with the Administrator. Copy of the reports were provided to the Licensee including the LIC 9099, LIC 9099-D and Appeal Rights. No Plan of Correction is due as the facility has closed.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20220224125758
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: PLACE CALLED HOME
FACILITY NUMBER: 392701008
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2022
Section Cited
CCR
87213
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Finances

The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency. Such request shall explain the need for disclosure. The licensing agency reserves the right to reject any financial report and to request additional information or examination including interim financial statements.
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Facility is closed therefore no plan of correction is requested.
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This requirement is not met as evidenced by: Based on interviews and record reviews of notice to quit, bank statements and resident files, the facility was not meeting it’s financial obligations. This poses a potential health and safety risk to resident in care.
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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: 04/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3