Complaint Investigation Report

197610121-7-21-2022-31-AS-CHAS-CKN288-20221028170955

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD., STE. 250

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

07/19/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20220719124525

At approximately 1:45 p.m. on 07/21/2022 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the administrator and disclosed the reason for the visit.

Regarding the allegation above, it was alleged the facility overcharged Resident #1 (R1) for the month of February 2022. To investigate the allegation, LPA interviewed R1 at approximately 2:10 p.m. on 07/21/2022 and interviewed the administrator at approximately 2:45 p.m. on 07/21/2022. LPA also conducted a record review at 3:15 p.m. on 07/21/2022. From interviews, R1 stated they should have been charged the Supplemental Security Income (SSI) rate from 02/18/2022 to 03/01/2022 instead of the Basic Rate. From record review, R1 signed an admission agreement on 02/18/2022 under the Basic Rate of $2500 from private funds. R1 stated they did sign the agreement at the time but would dispute the amount later. The administrator noted that R1 was not eligible for SSI funding when they initially moved in. The administrator also explained SSI and Assisted Living Waiver (ALW) eligibility to R1. Based on interviews and record review, though the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.