Complaint Investigation Report

306000295-10-3-2022-22-AS-AORZ-CKCQ6J-20221019115337

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 770 THE CITY DR., SUITE 7100

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

09/02/2022 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20220902113459

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry by Administrator Elena Weiner and explained the reason for the visit.

During the course of the investigation, LPA toured the facility, interviewed staff and witness as well as reviewed and obtained pertinent information such as facility billing invoice. Regarding the allegation that facility did not issue refund, the investigation revealed the following: Resident 1 (R1) resided at the facility from 06/08/2022 through 6/17/2022. Resident was sent out to the hospital on 06/17/2022 and family moved resident out of the facility without a written thirty day notice. Per health and safety code, a refund of 80 percent of the preadmission fee, minus $500, is due back if resident moves out within the first month. Facility did not refund any money to the resident's responsible party. Based on observations made and interviews conducted, 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) are being cited on the attached LIC 9099D.