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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609011
Report Date: 09/09/2025
Date Signed: 09/09/2025 04:34:08 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
02/21/2025 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20250221124252
FACILITY NAME:STRAWBERRY COTTAGEFACILITY NUMBER:
197609011
ADMINISTRATOR:GORY, MONICAFACILITY TYPE:
740
ADDRESS:43732 SENTRY LANETELEPHONE:
(661) 266-7995
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 3DATE:
09/09/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Monica Gory - AdministratorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide resident with a 60 day rent increase notice
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/09/2025 Licensing Program Analysts (LPA) Evelin Rios conducted an unannounced subsequent complaint visit for the above mentioned allegation. LPA met with Monica Gory, the administrator and explained the purpose of the visit. An entrance interview was conducted with the administrator. Present in the home was staff #1 (S1) and two (02) out of three (03) residents. A third resident arrived at approximately 2:15PM.

Allegation: Staff did not provide resident with a 60 day rent increase notice. It was alleged that Resident #1’s (R1’s) responsible party received a notification of rate increase on 02/06/2025 with effective date 01/01/2025.

To investigate the allegation LPA Rios conducted an initial visit on 02/25/2025. During initial visit LPA conducted an interview with the administrator and staff present. From approximately 10:54 a.m. to 1:26 p.m., LPA reviewed resident records and obtained documents such as but not limited to R1’s admission agreement, Assisted Living Waiver documentation, and a resident's copy of rate increase notification.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025
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 4
Control Number 31-AS-20250221124252
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: STRAWBERRY COTTAGE
FACILITY NUMBER: 197609011
VISIT DATE: 09/09/2025
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
(Continued from LIC9099) At 2:00 p.m. LPA conducted a physical plant tour to ensure the health and safety of the residents in care. While conducting the physical plant tour LPA attempted to interview resident #3 (R3), but they refused to be interviewed. LPA attempted to interview resident #4 (R4) but they were sleeping. LPA attempted to interview resident #5 (R5) but they did not respond to questions. From approximately 2:25 p.m. to 2:40 p.m., LPA conducted interviews with two (2) residents, Resident #1 (R1) and Resident #2 (R2).

LPA’s interview with the administrator revealed that R1 receives Supplemental Security Income (SSI) and is an Assisted Living Waiver (ALW) participant. The administrator stated that the facility planned to increase its fees in alignment with Social Security rate adjustments for 2025. According to the administrator, R1’s ALW case worker advised that a 30-day notice would be sufficient, and the facility subsequently issued a rate increase notice to R1 and their responsible party on 02/06/2025 with effective date 01/01/2025. According to the administrator a payment for R1 was actually received on April 2025 after a notice of failure to pay the increased rate was sent to R1 and their responsible party in March 2025.

LPA reviewed the Non-Medical Out-of-Home Care (NMOHC) Payment Standard for Individuals in Licensed Facilities, which confirmed that the payment standard did increase effective January 1, 2025. While the rate increase itself was appropriate, the facility’s own admission agreement with the resident’s representative verbatim states: “The facility reserves the right to increase the basic monthly fee, its rate structure for services including its fees for its levels of care by providing a 60-day written notice”. Furthermore, Effective January 1, 2025, Health and Safety Code section 1569.655 requires that written notice of any rate increase be provided no less than 90 days in advance to residents or their representatives. Based on interviews and record review, the allegation is deemed Substantiated at this time.

Exit interview conducted. Copy of report provided. Appeal rights provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20250221124252
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: STRAWBERRY COTTAGE
FACILITY NUMBER: 197609011
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2025
Section Cited
HSC
1569.655(a)
1
2
3
4
5
6
7
(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents... the licensee shall provide no less than 90 days’ prior written notice to the residents or the residents’ representatives setting forth the amount of the increase... This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Administrator shall read the cited Health and Safety Code and submit a statement of understanding to LPA by POC due date.
8
9
10
11
12
13
14
Based on interviews and record review, the licensee did not ensure to provide a written notice to R1 and their residents’ representatives at least 90 days prior to increasing rates of fees which posses a potential 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.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4