Complaint Investigation Report

The investigation revealed the following: In regards to the allegation, "Staff did not provide a copy of the admission agreement " it was alleged that the facility staff did provide an copy of R1's admission agreement when requested by family. (5) of (5) staff interviewed denied the allegation. (4) of (5) residents could not corroborate the allegation. Interviews show that a copy of R1's admission agreement was requested by relatives of R1 and were not provided by staff. Interviews show that R1 provided the facility staff with a letter stating that R1 gives their relative permission to receive such information. LPA observed the letter on file which was dated on 9/28/21. LPA's initial visit was conducted on 12/2/21 where the admissions agreement had yet to be provided to the relative that requested the agreement, this shows that the staff failed to provide the admissions agreement when requested.

In regards to the allegation, "Facility has inadequate record keeping for the residents" it was alleged that the facility could not provide a breakdown of R1's current pay rate as stated in the admissions agreement. (5) of (5) staff interviewed denied the allegation. (4) of (5) residents could not corroborate the allegation. Interviews show that R1's pay rate according to their admissions agreement Schedule A is $1300. Interviews state that R1's rate was calculated by adding $1200 as the base monthly fee and $100 for assisted living level of care rate. R1 has been receiving medicine management since they were admitted and that is defined as "level 1" care in the admissions agreement. R1's admissions agreement on file does not show the breakdown of the 1300 explained during interviews and staff interviewed were not able to explain why it did not show on the admissions agreement. Due to this discrepancy, the facility failed to have adequate record keeping of R1's file.

Based on interviews conducted, the preponderance of evidence standard has been met, therefore the allegation(s) are found to be substantiated. California Code of Regulations, Title 22, citations are being cited on the attached LIC 9099D.

A copy of this report was provided to Administrator Pamela Junge. Appeal rights were discussed and provided.