075600632-11-9-2023-15-AS-KHOS-CY8L3V-20231205072435

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075600632
Report Date: 11/09/2023
Date Signed: 11/09/2023 02:30:34 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/01/2023 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20231101154931

FACILITY NAME:	TENDER TOUCH RESIDENTIAL CARE HOME		FACILITY NUMBER:	075600632
ADMINISTRATOR:	CRUZ, ESTRELLITA S.		FACILITY TYPE:	740
ADDRESS:	58 MIDHILL ROAD		TELEPHONE:	(925) 228-5683
CITY:	MARTINEZ	STATE: CA	ZIP CODE:	94553
CAPACITY:	6	CENSUS: 5	DATE:	11/09/2023
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Estrellita Cruz, Administrator		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

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Facility did not issue a refund according to the resident's admission agreement

INVESTIGATION FINDINGS:

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On 11/09/23 at 12:15 PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with administrator (ADM), gathered information and delivered investigation finding of above allegation. LPA explained the purpose of the visit with ADM.

During investigation, the department obtained the following documents from administrator – resident’s admission agreement, monthly invoices.

Continued on next page, LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20231101154931

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: TENDER TOUCH RESIDENTIAL CARE HOME	FACILITY NUMBER: 075600632
	VISIT DATE: 11/09/2023

NARRATIVE

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Allegation: Facility did not issue a refund according to the resident's admission agreement.
Investigation Finding: Substantiated
During investigation, LPA interviewed staff (ADM) who stated that the resident (R1) was first admitted at the facility on 06/15/23. ADM confirmed with LPA that R1’s authorized representative (POA) paid her a total of $16,000 in advance monthly fees and security deposit by separate checks with the following details: R1’s security deposit ($5,500) paid in advance by POA on 06/20/23 with check# 454, last month’s basic services rent ($5,500) paid in advance by POA on 06/16/23 with check# 453 and monthly basic services rent from 08/15/23 until 09/14/23 ($5,000) paid in advance by POA on 07/14/23 with check# 466.

Review of R1’s admission agreement dated 06/15/23 and signed copies of R1’s monthly basic services invoices and security deposit dated 06/16/23, 06/20/23 and 07/14/23 showed ADM agreed to reimburse R1’s POA the total amount of $16,000 for advanced monthly fees and security deposit. LPA observed ADM failed to return the refund for advanced monthly fees paid by POA within 15 days after R1 passed away on 08/12/23 and R1’s personal property was removed on 08/13/23.

Based on the department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that facility did not issue a refund according to the resident's admission agreement was found to be substantiated.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted, appeal rights and copy of report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20231101154931

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: TENDER TOUCH RESIDENTIAL CARE HOME	FACILITY NUMBER: 075600632
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/09/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/13/2023 Section Cited CCR 87507(C)(1)	1 2 3 4 5 6 7	Any fee that is charged prior to or after admission, shall be clearly specified. 1. If a licensee charges a preadmission fee, the licensee must provide the applicant or his or her representative with a written general statement describing all costs associated with the preadmission fee charges and stating that the preadmission fee is refundable and describing conditions for the refund.	1 2 3 4 5 6 7	On or before POC due date, administrator (ADM) agreed to issue a refund of $16,000 on 11/10/23 to R1's POA in fulfillment of reimbursement for advanced payment fees & security deposit given to ADM in June 2023.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by facility staff did not issue a refund according to the resident’s admission agreement which is a violation of Title 22 Section 87507.	8 9 10 11 12 13 14	ADM also agreed to read, understand and implement timely refund processing of advance fees in compliance with Title 22 Section 87507.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC9099 (FAS) - (06/04)

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