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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701087
Report Date: 09/12/2024
Date Signed: 09/12/2024 04:26:43 PM

Document Has Been Signed on 09/12/2024 04:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BONNIE'S CARE HOMEFACILITY NUMBER:
502701087
ADMINISTRATOR/
DIRECTOR:		YEPEZ, BONAIREFACILITY TYPE:
740
ADDRESS:2608 VENEMAN AVENUETELEPHONE:
(209) 248-7663
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 6CENSUS: 5DATE:
09/12/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Bonnaire Yepez and Maria AraizaTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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An Informal Conference was conducted today, 09/12/24, via Microsoft Teams. The purpose of the Informal Conference was to discuss the facilities non-compliance with Title 22 Regulations. Present at today's Informal Conference were: Licensing Program Manager (LPM) Lisa Rios, Licensing Program Analyst (LPA) Maja Jensen, Licensee/Administrator Bonnaire Yepez and facility care staff Maria Araiza. The informal conference process was explained during this meeting.

The facility has had 9 A type citations over the course of the last year. It was learned that the Licensee is in the process of selling the care home to Maria Araiza. Maria Araiza has an Administrator's certification that is pending with the Department and has submitted an application for a residential care facility for the elderly (RCFE) license to the Centralized Application Bureau (CAB) as of 9/11/24.

The following issues were discussed during the informal conference:
· Compliance requirements for the proposed change of ownership
· Resident Records
· Personal Rights
· Accountability of the Licensee

Licensees stated they will do the following to achieve continued and substantial compliance:
· Hire a full time Administrator by 9/16/24
· Submit signed copies of the change in ownership notification given to residents
· Submit evidence of TB tests for residents

Continued on LIC 809C....
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BONNIE'S CARE HOME
FACILITY NUMBER: 502701087
VISIT DATE: 09/12/2024
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The Licensee was advised that administrative action will be taken if the non-compliance issues persist. The Licensee and the RCFE applicant were advised that the application can be denied for substantial non-compliance.

The Department will increase monitoring to at least monthly until the change in ownership occurs or until the facility reaches substantial compliance.

A copy of this report was sent to the Licensee for electronic signature
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
LIC809 (FAS) - (06/04)
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