486803612-7-20-2023-21-AS-KMOA-CUJURZ-20230809154933

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803612
Report Date: 07/20/2023
Date Signed: 07/20/2023 12:00:49 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/17/2023 and conducted by Evaluator Carol Fowler

COMPLAINT CONTROL NUMBER: 21-AS-20230717165033

FACILITY NAME:	GARDEN OF EDEN		FACILITY NUMBER:	486803612
ADMINISTRATOR:	MILTON, SHERYL		FACILITY TYPE:	740
ADDRESS:	115 MENLO COURT		TELEPHONE:	(707) 654-8307
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94589
CAPACITY:	6	CENSUS: 2	DATE:	07/20/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Octavia Phea, Caregiver		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Unlawful eviction

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst Carol Fowler arrived to open a complaint investigation. LPA interviewed RP and Administrator.

During visit LPA interviewed Administrator via phone. The allegation that R1 was unlawfully evicted was corroborated in an interview with the Administrator, who confirmed that R1 was taken to the hospital by family and the Administrator refused to accept R1 back to the facility due to health issues, safety of residents and staff and felt R1needed a higher level of care. This poses a potential personal rights risk to the resident in care.

As a result of the investigation, the allegation Unlawful eviction is substantiated.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Carol Fowler	TELEPHONE: 707-588-5053
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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 2

Control Number 21-AS-20230717165033

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: GARDEN OF EDEN	FACILITY NUMBER: 486803612
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/31/2023 Section Cited CCR 87224(a)(4)(c)	1 2 3 4 5 6 7	Eviction Procedures. The licensee may, ... services, failure to comply with state or local law,... and/or a change of use of the facility. (4) If, after admission, it is ...has a need not previously identified and a reappraisal has been ...that the facility is not appropriate for the resident.	1 2 3 4 5 6 7	Licensee/Administrator to submit facility procedures and policies of Eviction Procedures and written plan of future compliance with this regulation. POC due 7/31/2023
	8 9 10 11 12 13 14	If, after admission, it is determined that the resident ...d pursuant to Section 87463, and the lic... facility is not .... Eviction Procedures. The licensee shall state in the notice to quit the reasons for the eviction with specific facts about the date, place,...sible party(s) with written notice of eviction. LPA observed during file review that R1 received an unlawful eviction notice.	8 9 10 11 12 13 14	Licensee/Administrator to ensure if evicting a resident from the facility that the written notice of eviction is within law-regulation. Ensure that all required party(s) are notified, including licensing agency.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Carol Fowler	TELEPHONE: 707-588-5053
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2