Complaint Investigation Report

496803595-12-3-2021-21-AS-HDBI-CBNQDC-20220215110432

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 101 GOLF COURSE DR. STE. A-230

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

11/29/2021 and conducted by Evaluator Dina Alviso

COMPLAINT CONTROL NUMBER: 21-AS-20211129115859

Josephine Blancaflor-Licensee/Administrator

Facility did not provide required due refund in a timely manner

Licensing Program Analyst(LPA) Dina Alviso arrived unannounced to conduct a complaint investigation regarding the above allegation and met with

Licensee/Administrator Josephine Blancaflor

Complaint alleges that a resident's responsible party was not refunded following resident's passing; Residents personal belongings were moved out 9/22/21. Licensee confirmed to the LPA that she had not reimbursed the due refund within the regulation/HSC required time frame.

The allegation that the facility did not provide required due refund in a timely manner is Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and Health and Safety Code. Appeal rights given to the Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.