<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603599
Report Date: 08/21/2022
Date Signed: 08/21/2022 04:15:22 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
03/08/2021 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20210308153537
FACILITY NAME:BEST ELDER CAREFACILITY NUMBER:
197603599
ADMINISTRATOR:IGID, FABIOLAFACILITY TYPE:
740
ADDRESS:37620 SIMI STREETTELEPHONE:
(661) 878-8105
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:6CENSUS: 4DATE:
08/21/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jubilee EgibTIME COMPLETED:
04:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not maintain records of residents' cash resources.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility. LPA met with Jubilee Egib and explained the reason for the visit. Jubilee Egib was designated by the Administrator as the responsible staff member to sign and accept the report.

It was alleged that Licensee purchased items for the residents which accounted for their P&I allowance and did not have records or receipts of such purchases for the residents. To investigate this allegation, on 03/16/2021, LPA Elizabeth Arambulo conducted and interview and requested records. On 08/20/2022, LPA interviewed two (02) staff and two (02) out of four (04) residents from 4:00 PM to 5:00 PM and requested documents at around 5:15 PM. LPA was unable to interview resident #3 was incoherent and resident #4 was asleep. On 08/21/2022, LPA interviewed one (01) staff from 11:00 AM to 11:20 AM.

(cont. on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye DugumaTELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2022
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-20210308153537
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: BEST ELDER CARE
FACILITY NUMBER: 197603599
VISIT DATE: 08/21/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During an interview, the Licensee stated that they are unable to produce store receipts for Resident #1 (R1) and Resident #2 (R2)’s Personal and Incidental Fund expenditures for the period in question. A record request and review for R1 and R2 also confirmed that the Licensee failed to keep store receipts for Personal and Incidental Fund expenditures prior to March 2021. Based on interview and record review, the allegation is SUBSTANTIATED at this time.

Pursuant to Title 22 Div. 6 Ch. 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC9099-D):

No health and safety hazards noted during the visit. Exit interview was conducted, appeal rights were discussed, and a copy of report was issued. No further action at this time.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye DugumaTELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20210308153537
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: BEST ELDER CARE
FACILITY NUMBER: 197603599
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2022
Section Cited
CCR
87217(g)(B)
1
2
3
4
5
6
7
87217 Safeguards for Resident Cash, Personal Property, and Valuables: (g) Each licensee shall maintain... accurate records of cash resources... including, but not limited to...: (B) An acceptable receipt where purchases are made for the resident, from his account, is the store receipt.
1
2
3
4
5
6
7
The Administrator will review Section 87217 (g)(B) and will inform in writing explaining how they will ensure to follow Title 22 Regulations with regards to maintaining adequate safeguards and accurate records of cash resources, i.e,. store receipts.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above as the facility did not maintain accurate records of cash resources and receipts which poses an immediate Health, Safety or Personal Rights risk to residents in care.
8
9
10
11
12
13
14
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: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye DugumaTELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3