197606945-8-29-2023-28-AS-RORN-CV8MAD-20230831092609

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606945
Report Date: 08/29/2023
Date Signed: 08/29/2023 01:38:21 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/28/2023 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230828121728

FACILITY NAME:	BROOKDALE CENTRAL WHITTIER		FACILITY NUMBER:	197606945
ADMINISTRATOR:	BARBARA TYLER		FACILITY TYPE:	740
ADDRESS:	8101 S PAINTER AVE		TELEPHONE:	(562) 698-0596
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90602
CAPACITY:	92	CENSUS: 49	DATE:	08/29/2023
		UNANNOUNCED	TIME BEGAN:	10:17 AM
MET WITH:	Sanjay Kabadi, Executive Director		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Facility did not provide refund to representative.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint investigation visit in regards to the allegation listed above. LPA discussed the purpose of the visit with Executive Director Sanjay Kabadi.

The investigation consisted of: A tour of the common areas and file review was conducted. Staff (S1- S3) were interviewed. Resident (R1's) file documents were reviewed. The following documents were obtained: Identification and Emergency Information/Face Sheet, Admission Record, Physician's Report, Residency Agreement, R1's 30-Day Notice, Plan of Operation, billing invoice information, LIC 500 Personnel Report, and resident roster.

***See narrative summary on next page.***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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-20230828121728

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE CENTRAL WHITTIER	FACILITY NUMBER: 197606945
	VISIT DATE: 08/29/2023

NARRATIVE

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Allegation: Facility did not provide refund to representative. It is alleged the facility did not refund resident (R1's) authorized representative the correct amount after residency agreement was terminated. Per, authorized representative resident (R1) never physically moved in to the facility because MD did not clear the resident for move in, and former Executive Director Joshua Castillo allegedly promised a full Community Fee rate refund if R1 moved out before 90 days. Based on interviews conducted and file review, the findings indicate that a Residency Agreement was signed on April 11, 2023 by R1's authorized representative, and the resident's personal belongings were moved in by family even though R1 did not physically move in. According to staff interviews, resident (R1) refused to move in and family thought they could convince R1 by moving in the belongings and bringing the resident to dine at the facility several times. However, R1's representative issued a 30-day Notice on May 23, 2023. Resident (R1) was discharged from the facility on June 15, 2023. Current Executive Director Sanjay Kabadi came to an agreement with R1's authorized representative that the refund amount would be pro rated from discharge date, instead of 30 days from notice.

Per Plan of Operation, once a party enters a Residency Agreement, and the resident leaves for any reason within the third month month of residency, the party is entitled to a refund of 40% of the refundable amount.
The Community Fee rate is $2,750.00. Rent for the month of June 2023 ( 6/1 - 6/15) was pro rated as $1,695.75. On June 26, 2023 a refund in the amount of $3,303.02 was issued to authorized representative. Instead of getting refunded $1,100.00, they were refunded $2,200 as a good faith gesture since the resident never physically moved in. The facility Account history billing report was reviewed. No financial discrepancy was found.

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 conducted with Executive Director Sanjay Kabadi. A copy of the report was issued.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC9099 (FAS) - (06/04)

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