Complaint Investigation Report

Review of resident (R1's) file indicated that a rent increase was established via Admission Agreement signed on 12/04/2022, with a $500 increase from previous Admission Agreement signed on 7/01/2020. During inspection conducted on 12/12/2022, LPA requested a copy of the written notice used in the rate increase for R1. Facility did not provide a written notice to LPA during inspection.

Interviews conducted with Licensee and facility owner indicated that the rate increase was due to a change in level of care. An LIC 602 was completed on 4/20/2022 for R1 to identify changes in care. Interviews with Licensee and facility owner indicated that no written notice was provided to R1's authorized representative prior to the change in rate or the signing of R1's Admission Agreement on 12/04/2022.

Allegation: Facility did not provide invoice as stated on Admission Agreement

R1's Admission Agreement (signed 7/01/2020) states "the billing and payment policies and procedures are: An invoice will be given to the resident and/or responsible party on the first of each month." R1's Admission Agreement (signed 12/04/2022) states "the billing and payment policies and procedures are: invoice will be sent to resident responsible part." During inspection conducted on 12/12/2022, LPA requested a copy of the invoices for R1's rent sent to R1's authorized representative.

Interviews conducted with Licensee and facility owner indicated that an invoice for some months (exact months were not identified) were not provided to R1's authorized representative. Facility did not provide any invoice copies to LPA during 12/12/2022 inspection.

Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D page.

Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Administrator's signature on these forms acknowledges receipt of these documents.