Complaint Investigation Report

374604305-1-30-2023-18-AS-DMUN-CP4R7V-20230216114655

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

12/15/2022 and conducted by Evaluator Chinwe Nwogene

COMPLAINT CONTROL NUMBER: 18-AS-20221215120556

Staff did not refund authorized representative the proper amount after residents’ death.

Licensing Program Analyst (LPA), Chinwe Nwogene conducted an unannounced visit to conclude the complaint investigation into the allegation listed above. LPA met Caregiver, Alma Reyes who was informed of the purpose of the visit. During the investigation, Staff and Resident’s Responsible Party (RP) was interviewed, and Resident file was reviewed.

Regarding the allegation “Staff did not refund authorized representative the proper amount after residents’ death”. LPA’s interview with Resident’s Responsible Party (RP) revealed resident paid $4000 for December 2022 rent, resident passed away on 12/4/2022 and resident’s belongings was removed from the facility on 12/6/2022. The interview revealed resident was only reimbursed $2000 for half of the month. LPA interviewed house manager who stated facility bill’s customers based on level of care and not daily rates. LPA interviewed facility accountant who acknowledged resident should receive more refund and will be issuing resident a refund. LPA reviewed resident’s Admission Agreement. Admission Agreement doesn’t show resident’s daily rate or rate for all basic services which the facility is required to provide.

Based on LPA’s interviews and file review the preponderance of evidence standard has been met. Therefore, the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division & Chapter number 6) are being cited on the attached LIC9099D). An exit interview was conducted, and a copy of this report was reviewed with and provided to Alma Reyes.