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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197601592
Report Date: 12/21/2022
Date Signed: 12/21/2022 08:54:33 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/10/2022 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20220210104450
FACILITY NAME:TRUDEZ HOME CAREFACILITY NUMBER:
197601592
ADMINISTRATOR:LOPEZ, VIRGILIOFACILITY TYPE:
740
ADDRESS:23844 VIA JACARATELEPHONE:
(661) 259-7019
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY:6CENSUS: 2DATE:
12/21/2022
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Consuello Cipriano, Staff MemberTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility has not providing refund after residents death
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Panushkina conducted a subsequent complaint visit to this location to deliver the findings on the above allegation. LPA met with Consuello Cipriano, Staff Member, who granted access to the facility. Administrator was contacted and LPA explained the reason for the visit. LPA was informed that the Administrator cannot come to the facility and designated one of the staff members to sign the report.

It is being alleged that staff failed to provide a refund to Resident#1 (R1)’s family after R1 passed and R1’s belongings have been removed from the facility. During the investigation LPA reviewed and obtained copies of pertinent facility and R1’s records. LPA also conducted interviews with staff and the R1’s family.

Interviews revealed that R1 was admitted to the facility on 09/01/2021 with R1’s rent for the month of September 2021 paid in full. R1 passed away on 09/07/2021. Furthermore, interviews revealed that R1 had no
Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
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 3
Control Number 31-AS-20220210104450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: TRUDEZ HOME CARE
FACILITY NUMBER: 197601592
VISIT DATE: 12/21/2022
NARRATIVE
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belongings that had to be removed. A refund was requested by R1's family; however, a prorated refund was/has not been issued. Based on R1’s admission agreement, Health and Safety Code 1569.652 and Assembly Bill 261 a refund is to be issued within 15 days after the personal property of a resident has been removed. Therefore, based on the information obtained, the allegation is deemed Substantiated.

Exit interview conducted, deficiency, appeal rights discussed, and a copy of this report was issued
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
LIC9099 (FAS) - (06/04)
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Control Number 31-AS-20220210104450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TRUDEZ HOME CARE
FACILITY NUMBER: 197601592
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/28/2022
Section Cited
HSC
1569.652(c)
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Termination of admission agreement upon death of resident; removal of resident’s... A refund of any fees paid in advance covering the time after the resident’s personal property has been removed... within 15 days after the personal property is removed.

This requirement is not met as evidenced by:
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Administrator will have to pay the pro-rated amount to R1's responsible party for the remaining days of September after R1 passed away and their belongings were removed. R1's rate for basic services was $2100/ month at the time of passing. Proof copy of check will be emailed to LPA by POC date
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Based on record review & interview, licensee did not issue a refund within 15 days of R1's personal property being removed which posed a potential 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: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
LIC9099 (FAS) - (06/04)
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