Complaint Investigation Report

019200509-8-23-2024-15-AS-HHUL-D8SRUG-20240904131954

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1515 CLAY STREET, STE. 310

This is an official report of an unannounced visit/investigation of a complaint received in our office on

06/13/2023 and conducted by Evaluator Grace Luk

COMPLAINT CONTROL NUMBER: 15-AS-20230613112652

Staff are charging resident for services not rendered

On 8/23/2024 at 11:45AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct complaint investigation and deliver complaint findings for the allegation above. LPA met with Memory Care Director, Marissa Baldeomero.

During the investigation, LPA interviewed 3 residents and 3 staff. LPA obtained and reviewed documents (admission agreement, emergency information, care plan, physician's report, resident assessments, and resident detail ledger). Resident assessment dated 11/10/2022 indicated that resident (R1) was a level one (1) for care. However, R1's detail ledger revealed that R1 was charged for level three (3) care for dates after 11/10/2022.

Based on LPA information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED.

Exit interview conducted. A copy of this report and appeal rights provided.