Complaint Investigation Report

107209006-8-12-2022-24-AS-SMOA-CHEN3V-20220818100656

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

06/06/2022 and conducted by Evaluator Mary Garza

COMPLAINT CONTROL NUMBER: 24-AS-20220606135248

Licensee did not refund fees as per the Admission agreement.

On 8/122022 Licensing Program Analyst (LPA) M. Garza arrived at facility to deliver complaint findings. LPA contacted Administratorr, Pardeep Singh who stated they were unavailable. Administrator gave permision for Care Staff, Marites Paggao to complete tour and sign reports(s). LPA explained reason for visit and was permitted entry to facility. LPA was COVID pre-screened at time of entry. LPA toured facility and completed a health and safety check on residents in care. Residents observed in common areas and in rooms.

During investigation LPA reviewed resident files, admission agreement, hospice records and completed interviews. Interview with staff showed R1 was at the facility for less than two weeks. Interviews disclosed that a refund was not given for R1 to responsible party upon R1’s death. Admission agreement reviewed stated a refund would be given upon the death of a resident once residents belongings were removed from the facility. This allegation listed above is SUBSTANTIATED. Deficiency cited on 9099-D.

An exit interview completed. Appeal rights and a copy of this report was given.