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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801962
Report Date: 10/18/2022
Date Signed: 10/18/2022 10:43:24 AM


Document Has Been Signed on 10/18/2022 10:43 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:SINGLETREE CARING HANDSFACILITY NUMBER:
405801962
ADMINISTRATOR:HERBERT SALAMANCAFACILITY TYPE:
740
ADDRESS:1789 SINGLETREE COURTTELEPHONE:
(805) 439-1119
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93405
CAPACITY:6CENSUS: 4DATE:
10/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:44 AM
MET WITH: Herbert Salamanca TIME COMPLETED:
12:03 PM
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 At 8:45am, on 10/18/2022, Licensing Program Analyst (LPA) Jeffries conducted a case management visit. LPA met with Herbert Salamanca and explained the purpose of the visit.

On 10/17/2022, the Regional Office received information that the operator was not paying rent to the property owner. The Regional Office conducted a documentation review and discovered the Licensee, Caring Family Homes, LLC, was sold in December 2021, and a majority of the ownership of the LLC changed. This change would require a new license. The Regional Office also discovered operator Herbert Salamanca signed a new lease with the property owner for a term of 9/1/2020 to 9/1/2024, under the business name KHM Industries Inc. The previous lease issued to Caring Family Homes, LLC became invalid upon the new lease, and the Licensee Caring Family Homes, LLC lost control of property. The new lease and the sale of the Licensee LLC invalidated this facility’s license, and the facility is now considered unlicensed.

A Notice of Operation in Violation of the Law was issued to operator Herbert Salamanca today. The operator was advised that a retroactive civil penalty of $100 per day per resident shall be assessed on the 16th day from the original date of the Notice of Operation in Violation of the Law for the operation of an unlicensed facility. If the operator has not ceased operation or submitted a completed application for licensure within 15 calendar days of the issuance of this notice. On the 16th day from the notice, if the unlicensed operation continues to operate, a $200 per resident per day will be assessed until a completed application is submitted or the operation ceases. The operator may submit an application at the Woodland Hills Adult and Senior Care Regional Office located 21731 Ventura Blvd STE 250, Woodland Hills, 91364. The operator may go to www.ccld.ca.gov for orientation information.

Exit interview conducted. Facility evaluation report and Notice of Operation in Violation of the Law issued.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
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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