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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005571
Report Date: 05/26/2022
Date Signed: 05/27/2022 11:10:49 AM

Document Has Been Signed on 05/27/2022 11:10 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:ENCLAVE AT THE DELTAFACILITY NUMBER:
397005571
ADMINISTRATOR:LEAH B ZUBIATEFACILITY TYPE:
735
ADDRESS:4951 EIGHT MILE ROADTELEPHONE:
(209) 210-4863
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 45CENSUS: 41DATE:
05/26/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Leah ZubiateTIME COMPLETED:
05:00 PM
NARRATIVE
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A virtual informal office meeting was conducted today with CCL ASCP Regional Offices including Sacramento South and Fresno via Microsoft Teams.

The purpose of this meeting was to discuss findings from the solvency audit conducted by the Department.

Present at the meeting were Regional Managers (RM) Brenda White and Alycia Berryman, Licensing Program Managers See Moua, Liza King, Sergiy Pidgimy and Maribeth Senty, Licensing Program Analysts Maja Jensen, Kerry Hiratsku, Mary Garza and Lady Cabrera, Supervising Auditor Jacqueline Juarez and Auditor Diana Chapman.
Licensee Representative for Everwell Facilities included: Dr. Christopher Zubiate, Madison Fetyko and Tina Perez
This meeting is a result of the solvency audit stemming from a complaint received:

· On 01/19/2021 (27-AS-20210119094215) and 01/23/2021 (27-AS-20210123161803) the Sacramento South Regional Office received complaints of financial concerns at the facility and requested a trust audit be conducted by the Department’s audit section.

· On 04/02/2021(24-AS-20210402160438) the Fresno Regional Office received complaint(s) of financial concerns at the facility and requested a trust audit be conducted by the Department’s audit section.

Continued on 809C...
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: ENCLAVE AT THE DELTA
FACILITY NUMBER: 397005571
VISIT DATE: 05/26/2022
NARRATIVE
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The Audit findings were as follows:

· Licensee did not properly maintain accountancy for client P&I funds
· Licensee is not distributing P&I to clients
· Licensee is not allowing the residents to leave the facility to purchase items of their choice.
· Licensee is not securing all of the client’s cash resources either at the licensed facility or in an authorized financial institution
· The licensee has a surety bond for $5,000. The bond amount is not sufficient to cover the cash resources maintained by the licensee.

The investigation revealed that resident's funds are accounted for but were not distributed according to regulations.



Per the California Code of Regulations, Title 22, Divsion 6, Chapter 8 the following deficiencies were observed (see LIC 809-D) were cited during this meeting. Failure to correct the deficiency may result in civil penalties. An exit interview was conducted via phone and the report was emailed accompanied by the appeals rights, return receipt requested.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/27/2022 11:10 AM - It Cannot Be Edited


Created By: Maja Jensen On 05/26/2022 at 10:35 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ENCLAVE AT THE DELTA
FACILITY NUMBER: 397005571

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2022
Section Cited
CCR
80072(a)(6)

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Personal Rights:
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(6) To leave or depart the facility at any time.

The following regulation was not met as observed by:
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The licensee agrees that resident’s funds will be redistributed. by 6/27/22 The facility will provide 405s for all residents with contact information of the conservators for all residents on how excessive funds will be spent by 6/27/22.
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The clients are not allowed to leave the facility to purchase items of their choice. They are only allowed to spend money on snacks purchased by the facility, purchase items through online shopping, and buy cigarettes that the facility has purchased. This poses a potential risk to resident's rights.
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Type B
05/26/2022
Section Cited
CCR80026(i)(1-4)

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Safeguards for Resident Cash, Personal Property, and Valuables of Residents:
Immediately upon admission of a client, all of his/her cash resources entrusted to the licensee and not kept in the licensed facility shall be deposited in any type of bank, savings and loan, or credit union account meeting the following requirements:
(1) The account shall be maintained as a trust account separate from the personal or business accounts of the licensee.
(2) The account title shall clearly note that the account contains client cash resources.
(3) The licensee shall provide access to the cash resources upon demand by the client or his/her authorized representative.
(4) The account shall be maintained in a local bank, savings and loan or credit union authorized to do business in California, the deposits of which are insured by a branch of the Federal Government.

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The licensee agrees that resident’s funds will be redistributed by 6/27/22. The facility will provide LIC 405s for all residents with contact information of the conservators for all residents on how excessive funds will be spent by 6/27/22.
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Review of the cash resources ledgers (LIC 405’s) held both at the facility and at the corporate office. The ledgers provided showed cash secured at the corporate office location. This poses a potential risk to resident's rights.
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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 King
LICENSING EVALUATOR NAME:Maja Jensen
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022


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Document Has Been Signed on 05/27/2022 11:10 AM - It Cannot Be Edited


Created By: Maja Jensen On 05/26/2022 at 10:42 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ENCLAVE AT THE DELTA
FACILITY NUMBER: 397005571

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2022
Section Cited
CCR
80070(e)

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Client Records:
(e) A client's records shall be open to inspection by the client's authorized representative(s), if any.

The following regulation was not met as observed by:
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Licensee agrees that facility will provide LIC 405s or any available receipts requested by the resident’s payee in a timely and appropriate manner. Signed agreement of this will be submitted to the CCL Office by the due date of 6/27/22.
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Licensee did not provide all of the requested documentation to the audit section, which would have included all of the receipts of the Wealth Wagon participants. Licensee is not providing adequate documentation to the third-party payee and financial representative for some of the clients. This poses a potential risk to resident's rights.
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Type B
05/26/2022
Section Cited
CCR85072(a)(3)

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Personal Rights: (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. The following regulation was not met as observed by:
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The wealth wagon will cease operating effective 6/1/2022. The facility will submit proof that funds have been redistributed by the due date of 6/27/22
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Licensee was making a profit each day from each of the paid participants in the Wealth Wagon program. This poses a potential risk to resident's rights.
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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 King
LICENSING EVALUATOR NAME:Maja Jensen
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022


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Document Has Been Signed on 05/27/2022 11:10 AM - It Cannot Be Edited


Created By: Maja Jensen On 05/26/2022 at 10:49 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ENCLAVE AT THE DELTA
FACILITY NUMBER: 397005571

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2022
Section Cited
CCR
80025(a)-(e)

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Bonding:
(a) The licensee shall submit an affidavit, on a form provided by the licensing agency, stating whether he/she safeguards or will safeguard cash resources of clients and the maximum amount of cash resources to be safeguarded for all clients or each client in any month. (b) All licensees, other than governmental entities, who are entrusted to care for and control clients' cash resources shall file or have on file with the licensing agency, a bond issued by a surety company to the State of California as principal. (c) The amount of the bond shall be according to the following schedule: AMOUNT SAFEGUARDED PER MONTH BOND REQUIRED $750 or less $1,000 $751 to $1,500 $2,000 Enclave at the Delta Page 9 $1,501 to $2,500 $3,000 Every further increment of $1,000 or fraction thereof shall require an additional $1,000 on the bond. (d) The licensee shall submit a new affidavit and bond to the licensing agency prior to the licensee safeguarding amounts of clients' cash resources in excess of the current bond. (e) Whenever the licensing agency determines that the amount of the bond is insufficient to provide necessary protection of clients' cash resources, or whenever the amount of any bond is impaired by any recovery against the bond, the licensing agency shall have the authority to require the licensee to file an additional bond in such amount as the licensing agency determines to be necessary to protect the clients' cash resources. This regulation was not met as observed by:
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The Licensee agrees to obtain a Surety Bond to meets its needs by 6/27/22 and proof of correction needs to be submitted to CCL office by due date.
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Review of the cash resources ledgers (LIC 405’s) held both at the facility and at the corporate office. The ledgers provided showed $8,207.43 cash secured at the corporate office location and in addition to funds held at each facility. The licensee has a surety bond for $5,000. The bond amount is not sufficient to cover the cash resources maintained by the licensee. This poses a potential risk to resident's rights.
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Type B
05/26/2022
Section Cited
CCR80064(a)

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Administrator – Qualification and Duties: (a) The administrator shall have the following qualifications: (2) Knowledge of the requirements for providing the type of care and supervision needed by clients, including ability to communicate with such clients. (3) Knowledge of and ability to comply with applicable law and regulation. (4) Ability to maintain or supervise the maintenance of financial and other records. The following regulation was not met as observed by:
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The Licensee agrees to have the Administrators read and acknowledge understanding of this regulation and submit proof to the CCL office by 6/27/22.
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Based on interview and procedures reviewed, the Administrator is unfamiliar with the regulations regarding Clients Records, Safeguarding Residents Cash, Bonding and the facilities compliance procedures to ensure accountability of these regulations are met. This poses a potential risk to resident's rights.
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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 King
LICENSING EVALUATOR NAME:Maja Jensen
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022


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