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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500306146
Report Date: 01/29/2021
Date Signed: 02/05/2021 12:47:59 PM

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:LAS PALMAS ESTATESFACILITY NUMBER:
500306146
ADMINISTRATOR:MILLER, KREGGFACILITY TYPE:
740
ADDRESS:1617 COLORADOTELEPHONE:
(209) 632-8841
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:89CENSUS: 80DATE:
01/29/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Kregg MillerTIME COMPLETED:
10:00 PM
NARRATIVE
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An Office Meeting was conducted today in the Sacramento South Regional Office. The meeting was conducted via telephone on 01/29/2021 at 4:00pm due to COVID-19 and pre-cautionary measures. The purpose of this office meeting is to discuss the facilities COVID outbreak, reporting requirements and residents being relocated. Present in the meeting was Regional Manager Krystall Moore, Licensing Program Managers Stephen Richardson and Czarrina Camilon-Lee, Licensing Program Analyst Suong Teh, Maryesther Sanchez, MSN, RN, PHN III Stanislaus County Public Health and the Licensee/Administrator Kregg Miller.

This report is being amended from the original meeting date 01/29/2021 due to Plan Of Corrections were not in place.

There are 80 residents currently at the facility.

Issues discussed during the meeting were:

- Staffing

- Safety

- Oversight

- Continue monitoring of the facility

- Submission of timely Incident Reports when reporting positive results

- Transferring residents without medical necessity

- Unlawful eviction

- Submitting a line list daily to the Local Health Department and to the Department.

The facility has stated they will do the following to achieve continued and substantial compliance:

- Submit the mitigation plan by Tuesday 02/02/2021

- Submit incident reports within 24 hours when notification is received of a positive result.

The Department will do the following:

A referral has been done for CDPH HAI to assist the Licensee with isolation/cohorting areas for positive residents.

- A referral has been done for CHAPCA to assist in Infection Control procedures.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, Deficiencies are being cited during this meeting. An exit interview was conducted with Kregg Miller via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6803
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021
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 4
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: LAS PALMAS ESTATES
FACILITY NUMBER: 500306146
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
02/05/2021
Section Cited

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87211(a)(2) Reporting Requirements:
(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:
(2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate.
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This requirement is not met as evidenced by: Based on records review and interview conducted. The Department learned the first positive case was on 12/30/2020, but it was not reported to licensing . Mitigation plan has not submitted to the RO by 01/24/2021. A daily line list was not submitted to the local health department to report positive cases. This violation poses a potential health, and safety risk to residents in care.
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Deficiency Dismissed
Type A
02/05/2021
Section Cited

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87468.1(b) Personal Rights:
(b) All residents in all residential care facilities for the elderly shall be protected from all of the actions specified in this subsection. A licensee or facility staff may not take any of the following actions, which also includes taking these actions wholly or partially on the basis of the actual or perceived sexual orientation, gender identity, gender expression, or human immunodeficiency virus (HIV) status, of a resident:
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This requirement was not met as evidence by: Based on the statement of the licensee removing residents from their homes without approval notices from families. This violation poses a potential health, and safety 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: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6803
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: LAS PALMAS ESTATES
FACILITY NUMBER: 500306146
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
02/05/2021
Section Cited

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87405(d)(2)Administrator - Qualifications and Duties:
(d)The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply.
(2)Knowledge of and ability to conform to the applicable laws, rules and regulations.
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This requirement was not met as evidenced by: Based on the licensee failing to demonstrate the ability to follow Title 22 guidance and understand implementation of regulations despite being given guidance. This violation poses a potential health, and safety risk to residents in care.
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Request Denied
Type A
02/05/2021
Section Cited

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1569.50(3) Conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California.
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The requirement was not met as evidenced by: Based on the licensee disregarding guidance from Regional Office and the Local Health Department. This violation poses health, and safety risk to the 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: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6803
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: LAS PALMAS ESTATES
FACILITY NUMBER: 500306146
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
01/30/2021
Section Cited

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87224 (a) Eviction Procedures:
a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5). The Department learned the facility administrator relocated residents without medical necessity and refused to take them back.
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This requirement was not met as evidenced by: Based on Licensee telling the Department and the Local Health Department that he would not allow the residents to return to the facility without appropriate needs. This violation poses a potential health and safety 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: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6803
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4