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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209006
Report Date: 08/12/2022
Date Signed: 08/12/2022 12:50:24 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, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/06/2022 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20220606135248
FACILITY NAME:RISING SUN CARE HOME INCFACILITY NUMBER:
107209006
ADMINISTRATOR:SINGH, PARDEEPFACILITY TYPE:
740
ADDRESS:154 N LIND AVETELEPHONE:
(559) 313-4515
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:6CENSUS: 5DATE:
08/12/2022
UNANNOUNCEDTIME BEGAN:
11:22 AM
MET WITH:Care Giver, Marites PaggaoTIME COMPLETED:
12:25 PM
ALLEGATION(S):
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Licensee did not refund fees as per the Admission agreement.
INVESTIGATION FINDINGS:
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On 8/122022 Licensing Program Analyst (LPA) M. Garza arrived at facility to deliver complaint findings. LPA contacted Administratorr, Pardeep Singh who stated they were unavailable. Administrator gave permision for Care Staff, Marites Paggao to complete tour and sign reports(s). LPA explained reason for visit and was permitted entry to facility. LPA was COVID pre-screened at time of entry. LPA toured facility and completed a health and safety check on residents in care. Residents observed in common areas and in rooms.

During investigation LPA reviewed resident files, admission agreement, hospice records and completed interviews. Interview with staff showed R1 was at the facility for less than two weeks. Interviews disclosed that a refund was not given for R1 to responsible party upon R1’s death. Admission agreement reviewed stated a refund would be given upon the death of a resident once residents belongings were removed from the facility. This allegation listed above is SUBSTANTIATED. Deficiency cited on 9099-D.

An exit interview completed. Appeal rights and a copy of this report was given.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 24-AS-20220606135248
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: RISING SUN CARE HOME INC
FACILITY NUMBER: 107209006
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2022
Section Cited
HSC
1569.652(c)
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1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds (c) A refund of any fees paid in advance...property has been removed from the facility shall be issued...within 15 days after the personal property is removed.
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Refund minus the amount of funds for 16 days R1 and belonging were at the faciity will be refunded immediately. Staff to complete training on regulation. Training material and sign in sheet to be provided to CCL by POC date.
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This requirement was not met as evidence by: LPA interviews with RP and Administrator. Interviews showed that a refund was not given in the required 15 days, once residents belongings had been removed from the facility. This poses a potential health and safety or personal rights risk to residents in care.
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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: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022
LIC9099 (FAS) - (06/04)
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