Facility Evaluation Report

An NCC was conducted on this date. Present at the meeting were: RM Brenda White, LPM See Moua and LPA Mary Garza, Licensee Josiane Jones, Attorney, Jacob Reinhardt and Direct Care Staff, Elaine Saucedo. The following deficiencies are being cited today:

· Based on records review, Licensee Representative Josiane Jones charged the resident $12,000.00 for board and care services when the signed Admission Agreement states the monthly rate for the resident is $6,000.00. A rate increase notice of $800.00 effective 1/1/2020 was in the resident’s file, however, this is no date of when this notice was given to the resident.

· Based on records review, a check of $375.00 was made out to staff Elaine. There is nothing in the resident’s file that documents what services were provided beyond the basic services in the Admission Agreement to warrant the payment.

Deficiencies are cited on the attached 809D per Title 22. Exit interview completed with Licensee, Josiane and . A copy of this report and appeal rights provided.