Complaint Investigation Report

This document has been amended to clarify findings, it does not change the findings delivered on 12/29/2022.

The investigation consisted of the following: On 12/28/2021 LPA Stephanie Cifuentes toured the inside and outside grounds of the facility to conduct a heal and safety check and requested copies of facility documents. On 12/28/2021, 1/25/2022 and 4/13/2022 LPA Cifuentes conducted interviews with facility staff and residents. During the course of the investigation LPA requested and received copies of the following: client roster, staff roster; ID and emergency information, physicians’ reports, admissions agreement, resident appraisal, monthly billing statements and all medical records to include any hospital records for Resident #1.

Allegation: Facility charging resident for services that are not being performed

It is alleged that facility is charging resident monthly for services that are not being completed by facility staff and not agreed upon by family. LPA Cifuentes reviewed facility records and found that the facility had three Service Change Approval forms on file for R1. Two of those, which were signed by facility staff, dated 7/11/2021 and 11/30/2021 were to increase residents care level to add assistance with their ADL’s. Per notes on the form dated 7/11/2021, family of R1 refused the change in services. Review of form dated 11/30/2021 show that a message was left for family but does not indicate an agreement to the change in services to resident. LPA Cifuentes received billing statements for R1 for the dates of July 2021 to May 2022. The statement dated 8/31/2021 shows charges for assisted living plus for the months of July, August and September. R1 was not previously being charged for any level of care. In the statement dated 9/31/2021 those charges were credited back. R1 was not charged for care in the initial bills sent for November, nor in the initial bill for December, but a second statement was sent for the month of December on December 10, 2021 with charges for a higher level of care for the months of December and January. These charges continued on the billing statement issued for January 2022 and rolled over to future billing statements even when the resident had left the facility. Interviews with staff 1-7 (S1-S7) indicate that facility residents are not paying for services they are not receiving, with some staff elaborating that R1 would deny all offers of assistance with their ADL’s. LPA spoke with residents 1-resident 8 (R1-R8) regarding allegation. R1 was unavailable and one other resident refused to answer. Out of those interviewed 1 out of the 8 stated they believed they were over charged.

Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title 22 Division 6 Chapter 8 is being cited (please see LIC9099D.)

Exit interview was conducted with Business Office Manager, Henry Reyes. A hard copy of the report and appeal rights were provided.