197607726-3-18-2022-31-AS-NGID-CDAPX6-20220408114146

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607726
Report Date: 03/18/2022
Date Signed: 03/18/2022 01:45:12 PM

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
11/09/2020 and conducted by Evaluator Melissa Ruiz

COMPLAINT CONTROL NUMBER: 31-AS-20201109154601

FACILITY NAME:	WILLIAM J. "PETE" KNIGHT VETERANS HOME-LANCASTER		FACILITY NUMBER:	197607726
ADMINISTRATOR:	ELVIE ANCHETA		FACILITY TYPE:	740
ADDRESS:	45221 30TH STREET WEST		TELEPHONE:	(661) 974-7035
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	60	CENSUS: 47	DATE:	03/18/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Elvie Ancheta		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Licensee did not adhere to admissions agreement.

INVESTIGATION FINDINGS:

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At 10:30 a.m. Licensing Program Analysts (LPAs) Melissa Ruiz and Shira Stamps arrived at the facility to conduct an unannounced subsequent complaint visit. LPAs were greeted by security staff and later met with the Administrator, Elvie Ancheta. An entrance interview was conducted, and LPAs explained the purpose of the visit.

On 11/13/20, LPA Shanahan conducted an initial 10-day visit. Due to the covid-19 pandemic, the visit was done virtually.

During today’s visit, LPAs were able to interview the Administrator, two (2) staff and LPAs attempted to interview a resident who no longer resides at the facility (R1). Additionally, LPAs collected pertinent documents related to this complaint such as R1’s admission agreement, financial status reports, and correspondence letters. It was alleged that the Licensee did not adhere to admissions agreement.

(cont. on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

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 31-AS-20201109154601

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: WILLIAM J. "PETE" KNIGHT VETERANS HOME-LANCASTER	FACILITY NUMBER: 197607726
	VISIT DATE: 03/18/2022

NARRATIVE

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Upon reviewing R1’s admission agreement, there is a legal declaration section that was signed and dated by R1 on August 27, 2018, the same date of admission and states the following:

“6. I agree to pay the prescribed amount of fees established by the Veterans Home. If awarded Aid and Attendance by the Veterans Administration, I agree to pay the State an amount equal to this award and in addition to my fees. I understand that refusal or non-payment of fees can result in my discharge from the Veterans Home.”

Based on interviews, this section is listed on all Admission Agreements for all residents.

LPAs conducted document review and interviews, which revealed that at the time of admission, R1’s total monthly fees were anywhere from $600.00 - $630.00. The monthly fees are calculated based on residents’ total income, which vary month to month. Sometime after that, R1’s monthly fees decreased to roughly $518.00, due to less total income per month since R1 was being deducted $207.80 in child support.

During the time of admission and thereafter, R1 had not been receiving Award and Attendance Benefits (A&A) by Department of Veterans Affairs. A letter given to R1 by the Department of Veterans Affairs granted A&A benefits on June 11, 2020 and was payable from July 1, 2020, totaling $1066.00 per month. Per the signed Admission Agreement, those fees are supposed to be collected by the State, per MVC § 1012.2.

Based on document review and interviews conducted, this allegation is unsubstantiated. No citations issued. Report was signed and delivered. An exit interview was conducted with the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

LIC9099 (FAS) - (06/04)

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