Complaint Investigation Report

107208995-8-23-2022-24-AS-MHON-CJBN3N-20220916100634

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

08/16/2022 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20220816153825

Facility not following admission agreement

On 08/23/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced and conducted an initial complaint investigation. LPA met with Administrator Linda Pope and explained the purpose of the visit and delivered finding.

During the course of the investigation, the Department conducted interview and records were reviewed. Department investigated the complaint alleging that facility not following admission agreement. Documentation obtained and reviewed, as well as interview conducted show that Licensee applied surcharge fee to resident that was not in the admission agreement.

Based on interview conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Under California Code of Regulations, Title 22, Division 6 & Chapter 8, are being cited on the attached LIC 9099D. Plan of correction was discussed with the Administrator. An exit interview was conducted, and a copy of this report and appeal rights was provided to Administrator.