Complaint Investigation Report

336423907-12-14-2021-18-AS-JESL-CS7SL6-20230526135749

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1650 SPRUCE ST STE 200 MS29-27

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

12/08/2021 and conducted by Evaluator Jesse Gardner

COMPLAINT CONTROL NUMBER: 18-AS-20211208135115

Facility failed to issue a refund of preadmission fee

Facility failed to provide full written disclosure of the preadmission fee charges and refund conditions

Licensing Program Analyst (LPA) Jesse Gardner arrived at the facility unannounced to investigate the above allegations. LPA identified himself and discussed the purpose of the visit with Caregiver Ana Ortiz. Ortiz called their Administrator Cori Cooper, and LPA spoke with them (over telephone).

Through interviews with Witness one (W1) and Administrator, it was determined that Client one (C1) had not been admitted to the facility, the family had not been issued a refund, and the admissions agreement was not a signed document per Title 22 Section 6 Chapter 8 Article 9 Resident Records 87507 Admission Agreements, these allegations were deemed to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted with Caregiver Ana Ortiz and a copy of this report along with LIC9099-D, LIC 811, and Appeal Rights were provided.