Complaint Investigation Report

079200801-8-22-2023-15-AS-KHOS-CV5L6P-20230828082903

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

06/30/2022 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20220630152422

Resident's Representative was not provided with a general description of costs pertaining to a rate increase.

On 08/22/23 at 2:20PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with executive director (ED) to deliver a plan of correction for above allegation that was not delivered by LPA C Fowler on 02/23/23. LPA explained the purpose of the visit with ED.

Resident's Representative was not provided with a general description of costs pertaining to a rate increase.

RP stated that the facility did not provide a description of costs pertaining to the rate increase. The Department requested description of cost pertaining to the rate increase, the Department received a copy of R1’s Resident Status Change Form which shows the effective date, new apartment style, apartment number and new rent amount and transfer reason (change in condition) however the RP stated that she did not receive any information. Based on interviews and record review the facility failed to provide the Department with proof of correspondence for the general description of cost pertaining to the rate change, therefore this allegation is SUBSTANTIATED. Exit interview conducted and a copy of this report and appeal rights provided.