Memory Lane Manor

Type of visit: Office

A Non-Compliance Conference (NCC) was conducted on this day, 09/22/2023, by the Sacramento South Regional Office via Microsoft Teams meeting. The purpose of this Non-Compliance Conference meeting was to discuss the deficiencies at Memory Lane Manor, the status of its license and ways to bring it back into compliance and avoid legal action. The focus of this meeting will be to discuss Memory Lane Manor’s change of status from a sole proprietorship to an LLC. This was completed on February 9, 2022 and would have required that the Licensee contact the Centralized Applications Bureau to apply for a new license. The other issue being discussed today is that the Licensee/Administrator is not listed as Associated to the facility. Present at the meeting were Licensing Program Manager (LPM) Liza King and Licensing Program Analysts (LPAs), Kimberly Viarella, Maja Jensen and Arielle Pascua. Representing Memory Lane Manor was Consuela Hozan-Farcas. The Non-Compliance Conference process was explained during this meeting to include the Administrative Process. The focus of the concerns at this time: · Status of Memory Lane Manor’s License o Sole Proprietorship vs LLC · Criminal background check for Licensee/Administrator · Deficiencies observed during annual inspection on 08/23/23 Licensee agreed to do the following in order to bring the facility into compliance no later than the following dates: Licensee will: apply for a Change of Ownership, dissolve the LLC, remain a sole proprietorship, or forfeit the license, within 7 days (09/22/2023). Licensee will notify CCL which action will be taken by Wednesday, 09/20/2023. A follow-up MicrosoftTeams conference will be conducted on Monday, September 25 to discuss the steps moving forward and the association of the Administrator to the facility. Exit interview conducted via telephone, and copy of report provided by email.the state’s words, verbatim · CDSS document, Sep 15, 2023

Allegation investigated: Uncleared adult living at the facility.

On 08/23/2023, Licensing Program Analysts (LPAs) Arielle Pascua and Kimberly Viarella arrived unannounced to this facility to conduct a complaint visit. LPAs were greeted by Licensee, Consuela Hozan-Farcas and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegation above. Current Census was 0. A tour of the facility was conducted. A brief interview with Licensee Hozan-Farcas was conducted. It was alleged that an uncleared adult was living at the facility. LPA Pascua conducted interviews and reviewed facility. Based on interviews conducted it was learned that this facility is not currently housing any residents at this time since January 2023. It was learned that the Licensee has allowed family members and family friends to reside at the facility while there are no residents in care. It was found that the Licensee has conducted tours of the facility to perspective residents and their families within the last few weeks. Substantiated Based on facility records, these individuals who are residing at the facility at this time are not fingerprint cleared to be at the facility. Based on observation, LPA conducted a facility tour on 08/15/2023 and 08/23/2023 and observed there were no residents in care at this time. LPA toured 4 resident bedrooms where it was observed that there were beds that were unmade, personal belongings such as adult and children clothing, shoes, blankets, pillows, hygiene products and toys. During both visits, it was observed that there were minors who were being home schooled at the facility. In addition, LPA toured the facility kitchen where it was observed to have canned goods and perishable food supply. Based on observations, review of records and information gathered through interviews, the above allegations were SUBSTANTIATED meaning that there was a preponderance of evidence to prove that the allegations occurred as alleged. An immediate civil penalty for $500 is being assessed for the violation of 87355(e)(1). An exit interview was conducted, a copy of the LIC9099, LIC9099-C, LIC9099-D, and appeals rights was provided to the Licensee at the end of this visit.the state’s words, verbatim · CDSS document, Aug 23, 2023 · control 27-AS-20230810121038

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Aug 24, 2023

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department This is not met as evidenced by: Based on observation, interview, and record review, the Licensee did not comply with the section above by ensuring the the individuals residing at the facility have criminal background checks. This poses an immediate health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Aug 23, 2023

Plan of correction: Licensee shall provide a statement of acknowlegthat states that they have read regulation 87355(e)(1). Licensee shall have a plan to remove individual from facility and obtain a proper criminal record clearance prior to residing at the facility.

Type of visit: Required - 1 Year

An unannounced annual inspection was completed by Licensing Program Analysts (LPAs) Kimberly Viarella and Arielle Pascua on 08/23/2023. LPAs identified themselves and the purpose of their visit to the Licensee, Consuela Hozan-Farcas. A brief interview followed. Census at the time was 0. The following Technical Assistance was provided during today's inspection. These concerns must be addressed and Licensing must be contacted for an additional inspection prior to the admittance of any residents. If Licensing is not informed, and the inspection is not completed prior to admitting any residents into care, Administrative Actions may be taken. All toxins shall be locked and inaccessible to residents in care. All prescription medications shall be locked and inaccessible to residents in care. Expiration dates shall be checked periodically and disposed appropriately. All resident accommodations shall include the required furniture: chest of drawers, bed, night stand, lamp/lighting sufficient for reading, and a chair. The facility shall be in good repair and all debris, broken appliances, furniture, medical equipment, bins, trash, suitcases, and other discarded items shall be removed from the facility's property. The Licensee shall remove the dried vegetation, weeds, and animal feces. The following shall be posted and visible to residents in care: the facility License, the Administrator's Certificate, the Emergency/Disaster Plan with facility sketch, and the poster of Resident Rights. The Licensee shall also post a calendar of activities menus for the residents in care. The Licensee shall repair/replace any missing window screens or screens with holes. All food items in the refrigerator, freezer, and pantry will be inspected and all expired items shall be disposed. Going forward, any food item once opened shall be dated appropriately as will any leftovers. The Licensee will submit the documentation to be associated to this facility. There shall be a designated space for personal items, for example, a change of clothes, handbags, coats, meals, medications, etc. Personal items shall not be stored in multiple bedrooms, drawers, or closets. There were no citations given today. A copy of this report was provided to the Licensee. Exit interview.the state’s words, verbatim · CDSS document, Aug 23, 2023

The state marks this report as 10 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Licensee Consuela Hozen - Farcas Continual Administrator's Certification expires 03/12/2023. There are currently 4 residents who reside at this home and there is 4 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. LPA confirmed all staff present is background cleared. Licensee did not have COVID 19 vaccine exemption forms on file for facility staff. LPA observed a fire extinguisher hanging on the wall in kitchen with no tag documenting expiration date or last checked date. LPA observed a large covered canopy in the front driveway with several boxes of personal belongings. The following deficiencies were cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. An exit interview was conducted with Licensee Consuela Hozen - Farcas and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 11, 2022

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Jul 25, 2022

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. The following requirement has not been met as evidenced by: The Licensee has several boxes of personal belongings in a canopy covering the entire driveway which poses a potential risk to the health, welfare, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 11, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facilities annual inspection. LPA met with Licensee Consuela Hozan - Farcas. There are currently 3 residents who reside at this home and there is 0 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Administrator and copy of report left at facilitythe state’s words, verbatim · CDSS document, Aug 4, 2021