197606301-11-13-2023-28-AS-RORN-CY2MLM-20231129084234

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606301
Report Date: 11/13/2023
Date Signed: 11/13/2023 01:55:03 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/07/2023 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231107160807

FACILITY NAME:	BROOKDALE MONROVIA		FACILITY NUMBER:	197606301
ADMINISTRATOR:	BALBIN, RALPH		FACILITY TYPE:	740
ADDRESS:	201 E FOOTHILL BLVD		TELEPHONE:	(626) 301-0204
CITY:	MONROVIA	STATE: CA	ZIP CODE:	91016
CAPACITY:	75	CENSUS: 57	DATE:	11/13/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Logan Harrison - Executive Director		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Facility failed to adhere the admission agreement.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced initial 10-day complaint visit and met with Executive Director Logan Harrison. The purpose of today’s visit was explained.

The investigation consisted of the following:
Interview with Executive Director Logan Harrison (person assigned to handle admissions, discharge and refunds, and interviews with 4 residents. LPA obtained resident roster, staff roster, and Resident #1’s (R1) facility files, admission agreement, Preplacement Appraisal Information, ID and Emergency Information, and R1’s 30-day notice to vacate.

(Continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

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 28-AS-20231107160807

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE MONROVIA	FACILITY NUMBER: 197606301
	VISIT DATE: 11/13/2023

NARRATIVE

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The investigation revealed the following:
Allegation: Facility failed to adhere the admission agreement.
It is alleged that the facility failed to credit the correct amount of R1’s refundable community fee ($2,000), resident was due a 80% credit on the fee but was provided with a 60% credit instead.
Per the admission agreement under section “III. Rates, A Community Fee, 3. Once you enter the Community, if this agreement terminates and you leave for any reason within the second month of residency, you are entitled to a refund of sixty percent (60%) of the refundable amount.” R1 was admitted to the facility on 8/24/23 (date granted access to apartment and given keys, resident fully moved in days after), R1 provided facility with 30-day notice to vacate apartment on 9/17/23 and vacated facility with all belongings on 9/18/23. Per R1 account history report, R1 was issued a credit in the amount of $1,200 which is 60% of the refundable amount. The 80% refundable amount would be for a resident “who terminates upon arrival to the facility and leaves for any reason within the first month of residency” or “decides after the completion of pre-admission appraisal (personal service assessment) not to enter the Community.” Due to R1 providing the 30-day notice on 9/17/23 would give them a vacate date of 10/17/23, which would be within the 2nd month of residency, granting R1 the 60% credit of the refundable amount which the $1,200 that was credited. LPA interviewed 4 residents during todays visit and 4 out of 4 residents stated that they feel the bookkeeping/administrative team are proactive and responsive when it comes to questions regarding fees and credits. R2 stated they have been in a situation when a credit was needed and the facility was responsive, took action and were “more than fair” with the credit that was given back to resident. LPA interviewed Executive Director Logan Harrison and he explained the credits issued that were listed on the account history report of R1 along with the admission agreement percentages for the Community Fee, since R1 was within their second month of residency the 60% is what was credited.

Based on statements and interviews conducted with staff/residents, review of R1 files and facility file records, there was not enough supportive evidence to concur with the reported allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided to Executive Director Logan Harrison.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

LIC9099 (FAS) - (06/04)

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