Complaint Investigation Report

Allegation #1: Staff did not provide requested records to resident’s responsible party.

The details of the complaint alleged that facility staff failed to provide records requested by the responsible party for resident #1 (R1). The complainant reported on multiple occasions requesteed a ledger documenting the payments made by (R1) to ensure accuracy. The complainant claimed to have been informed that the records were located at the corporate office.

According to resident #1 (R1’s) Identification and Emergency Information LIC 601 (dated: 05/11/22) and Admissions Agreement (dated: 05/11/22), (R1) was admitted at Burbank Senior Villa East on 05/11/22.

On 05/10/24, between 10:37 am – 11::01 am, the Department interviewed resident #1 (R1). (R1) stated that this matter has been resolved and had received all the necessary documents requested.

On 05/10/24, between 11:05 am – 11:31 am, the Department interviewed business manager staff #1 (S1). (S1) claimed to have provided (R1’s) responsible party with the following: (R1’s) Payer Ledger, Retirement Income Verification, Statement Invoice (dated: 10/2023), Notice of Rate Increase Letter, Payer Detail Ledger (11/22 thru 11/23), Copies of SS1 and SSA checks total amount of $1327.82, Personal check in amount of $400 and Admissions Agreement on 11/02/23 through an email process. The request was made by email from (R1’s) responsible party on 10/23/23 and evidence of email communications from (S1) and the responsible party on 10/27/23 and 11/02/22. (S1) confirmed that the facility cooperated with (R1’s) responsible party and provided all the necessary records requested. However, the (R1’s) ledger for prior months beginning 05/22 through 10/22 were in another accounting software program with the facility’s corporate office, and will take some additional days to obtain a copy. (S1) reported that (R1’s) responsible party did not request again for the statement aside from what (S1) provided on 11/02/23, and considered request to have been fulfilled.

A review of (R1’s) general ledger indicated (R1) was admitted with the amount for basic service of $1231.77 on 05/11/22. A reassessment of (R1’s) Medi-Cal with a shared cost brought the basic services to increase by $1344.82 effective 01/01/23. Effective 01/01/24 (R1’s) basic services increased to $1398.07. (R1) continued to make payments of $1,200.77 and $1327.82 and not the full amount which resulted in an open totaling balance of $215 as of 10/27/23. (Evaluation Report continues LIC 9099-C)