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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421703341
Report Date: 03/22/2022
Date Signed: 03/22/2022 11:27:22 AM


Document Has Been Signed on 03/22/2022 11:27 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:PITA BOARD AND CAREFACILITY NUMBER:
421703341
ADMINISTRATOR:CHRISTINE PITAFACILITY TYPE:
740
ADDRESS:259 MOONCRESTTELEPHONE:
(805) 934-2649
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:6CENSUS: 0DATE:
03/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Gregoria PitaTIME COMPLETED:
11:00 AM
NARRATIVE
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On 3/22/22 at 10:30 a.m., Licensing Program Analyst (LPA) Toan Luong conducted an unannounced on-site Case Management for closure at Pita Board and Care. LPA met with Licensee Gregoria Pita and explained the purpose of the visit.

During today's visit, it was reported by the Licensee that the property closed escrow, "sometimes last week." Licensee was unable to provide an exact date. LPA observed the facility to be vacant and without residents. Bedrooms were empty with only a bed and no belongings in storage space. The remaining residents moved out on 3/14/22. Between February 4, 2022 through March 15, 2022, LPA interviewed Licensee, administrator, residents, and residents' responsible party. During this time period, LPA requested Licensee to provide copies of documentation of 60-day eviction provided to residents and residents' responsible party. The letters were dated February 3 through February 12. One resident did not receive a 60-day notice until March. Community Care Licensing did not receive notification from the facility that the facility is closing 60 days before closing. LPA issued a citation base on Health and Safety Code 1569.682(a)(2) of not providing residents 60 day's notice.

LPA conducted exit interview and issued citation. LPA emailed appeal rights and report to Licensee.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Toan LuongTELEPHONE: (626) 419-1827
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 03/22/2022 11:27 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364


FACILITY NAME: PITA BOARD AND CARE
FACILITY NUMBER: 421703341

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/23/2022
Section Cited

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1569.682(a)(2)Transfer of resident upon forfeiture of license or change in use of facility....Provide each resident or the resident’s responsible person with a written notice no later than 60 days before the intended eviction...This requirement is not met as evidenced by:
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Based on interviews, the licensee did not comply with the section cited above, as a letters to responsible parties and residents were given less than 60 days notice of facility closure, which posed a potential health, safety, or personal rights risk to residents 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: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Toan LuongTELEPHONE: (626) 419-1827
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2