502700362-2-11-2021-27-AS-KHOS-BYBTDZ-20210217133911

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700362
Report Date: 02/10/2021
Date Signed: 02/11/2021 04:05:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2020 and conducted by Evaluator Stephenie Doub

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200911122452

FACILITY NAME:	STACIE'S CHALET MODESTO		FACILITY NUMBER:	502700362
ADMINISTRATOR:	PRADO, ROSIE		FACILITY TYPE:	740
ADDRESS:	808 MCHENRY AVE		TELEPHONE:	(209) 524-0808
CITY:	MODESTO	STATE: CA	ZIP CODE:	95350
CAPACITY:	120	CENSUS:	DATE:	02/10/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	James Wong & Patricia Wong, Licensee		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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The facility not financially solvent

INVESTIGATION FINDINGS:

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An Office meeting was held on this day via Microsoft Teams to discuss the findings of the complaint investigation of the allegation noted above. Present at the meeting was Regional Manager (RM) Krystall Moore, Licensing Program Manager (LPM) Liza King, LPA Stephenie Doub, Auditor Diana Chapman and faciltiy representatives James Wong, Patrica Wong, Jade Parker, Hatixhe Grbeshi, Robert Cantoria and Maria Cantoria.
The iniital 10-day visit was conducted on 9/11/2020. An audit was requested by the Department on 9/11/2020. During this visit, the findings from the audit was discussed with the facility representatives. Based on the audit it was found that the licensee is behind on monthly bills and does not have an adequate financial plan in place. Per audit, the licensee was behind on payments for multiple bills and their mortgage payment; the licensee/Corporation has long-term liabilities for creditior claims around $500.000. The licensee/Corporation has defaulted in over $2,000,000 in outstanding promissory notes. Based on the information provided, the allegation that the facility is not financially solvent was Substantiated.
(continued on page 2)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Krystall Moore	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021

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 3

Control Number 27-AS-20200911122452

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: STACIE'S CHALET MODESTO	FACILITY NUMBER: 502700362
	VISIT DATE: 02/10/2021

NARRATIVE

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continued from page 1)
This agency investigated the allegation noted and found the allegation to be substantiated meaning that there was a preponderance of evidence to prove that the allegation occurred as reported.

The following deficiencies were cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Licensee Representatives and a copy of this report was provided via email along with appeal rights. An electronic email read receipt confirms receiving these documents.

SUPERVISOR'S NAME: Krystall Moore	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20200911122452

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: STACIE'S CHALET MODESTO	FACILITY NUMBER: 502700362
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/10/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/10/2021 Section Cited CCR 87213	1 2 3 4 5 6 7	Finances. The licensee shall have a financial plan...that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required... This regulation was not met as evidence by:	1 2 3 4 5 6 7	The licensee is in the process of selling the facility and will update the Auditor of the completed sale. Should the sale not be completed the licensee will provide a plan to ensure stability by the POC date of 3/10/2021.
	8 9 10 11 12 13 14	The licensee did not ensure that that facility had a financial plan that assured sufficient resources to meet operating costs. Based on financial documents recieved and audit conducted, the facility was behind on payments and defaulted on liabilities. This poses a potential risk to residents in care.	8 9 10 11 12 13 14
	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: Krystall Moore	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021

LIC9099 (FAS) - (06/04)

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