Facility Evaluation Report

At approximately 9:40 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to initiate a Complaint Investigation for complaint 21-AS-20260115120823.

During file review, LPA observed a Deficiency unrelated to the complaint investigation. LPA observed that resident R1 was given a "Level of Care" rate increase. The notice of the level of care rate increase was dated 2/15/2024 with the rate increase beginning 3/1/2024. Resident R1 signed and dated the notice on 2/24/2024. California Health and Safety Code 1569.655(a) states, "If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days’ prior written notice to the residents or the residents’ representatives setting forth the amount of the increase and the reason or reasons for the increase, including a description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident." The notice of level of care rate increase given to the resident stated that the increase was not for an actual change of the resident's care level, but instead due to an increase in costs to provide services. As the required sixty (60) day notice was not given to the resident, this deficiency will be cited.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC-809D, LIC 811, Plan of Corrections and Appeal Rights discussed and provided to Caregiver Nicadao. Signature on form confirms receipt of documents.