Complaint Investigation Report

Allegation: Staff did not provide resident’s authorized representative a copy of the admission agreement in a timely manner. The complaint alleges that resident (R1's) responsible party never received a copy of the signed Admission Agreement after multiple requests addressed to Administration staff. Based on record review, the findings indicate that resident (R1) moved in to the facility on November 17, 2023. The Admission Agreement was provided until August 5, 2024. LPA obtained a copy of the Admission Agreement, and it was determined the Admission Agreement signed and provided to R1's responsible party is the former licensee's Admission Agreement. On 12/7/2023, the facility was issued a citation for issuing Admission Agreements that were in place when the facility was owned by a previous licensee. Administrator acknowledged they did not provide a copy, and the copy provided is not the correct form. Therefore, there is sufficient evidence to corroborate the allegation. A civil penalty is being assessed.

Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED . Deficiencies are being cited according to Title 22. See LIC 9099D.

Exit interview was conducted with Administrator Diana Bautista. A copy of the report and appeal rights were provided.