197609084-12-10-2020-28-AS-MVAO-BX2SYV-20210107131810

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609084
Report Date: 12/09/2020
Date Signed: 12/10/2020 01:53:21 PM

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
08/28/2019 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20190828112905

FACILITY NAME:	PARKVIEW OF GLENDALE		FACILITY NUMBER:	197609084
ADMINISTRATOR:	WILKENS, DAVID		FACILITY TYPE:	740
ADDRESS:	426 PIEDMONT AVE		TELEPHONE:	(925) 377-5197
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91206
CAPACITY:	135	CENSUS: 0	DATE:	12/09/2020
		UNANNOUNCED	TIME BEGAN:	03:39 PM
MET WITH:	April Taylor, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility did not provide residents all information required on rate increase notice.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza initiated a subsequent complaint investigation to deliver findings on the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator April Taylor.
The investigation consisted of the following: On 9/5/2019, an initial 10-day complaint visit was conducted. Residents (R1-R5), and staff (S1 &S2) were interviewed. A tour of the interior and exterior physical plant was conducted. NOTE: LPAs observed major exterior physical plant renovations. The interior physical plant ceilings were under construction; no major construction in the interior of the facility. Copies of resident file documents [admission agreements, face sheet, physician report], Addendum to Admission Agreement letter issued to residents in the month of May 2019, Notice of Increased Basic Monthly Fee issued on 8/23/2019, and Plan of Operation Section B7 (total of 3 pages) were obtained. During the course of the investigation LPA obtained an attorney letter dated 5/29/19 written to the facility by "CANHR Long Term Care Justice Advocacy", and the facility's attorney response letter dated 6/11/2019. On 5/6/2020, a resident's family member, and staff (S2) were interviewed via phone.
***SEE LIC 9099C for continuation of report.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2020

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-20190828112905

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: PARKVIEW OF GLENDALE	FACILITY NUMBER: 197609084
	VISIT DATE: 12/09/2020

NARRATIVE

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Allegation: "Facility did not provide residents all information required on rate increase notice." Based on review of documents "Addendum to Admission Agreement" dated May 2019, "Notice of Increased Basic Monthly Fee" issued on 8/23/2019 the findings indicate that the facility failed to provide residents proper notification of rate increase. Facility issued the 1st written notice of rate increases to residents and/or authorized representative, but the notice did not state the reason for the rent increase. CANHR Long Term Care Justice Advocacy informed the facility that the 1st notice issued was invalid, as it was missing required information. As a result, on August 23, 2019 the facility issued a 2nd notice superseding the 1st notice. The 2nd notice included the reason for the increase, and description of additional costs to the resident if applicable. Five (5) out of five (5) residents interviewed confirmed they received two rate increase notices. Administrator David Wilkens and Assistant Director April Taylor acknowledged that the 2nd notice was issued because the 1st notice was missing the reason for the rate increase. Document evidence to support this allegation was obtained.

Based on review of documents, information obtained from interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 3.2, Article 06. See LIC 9099D.

A telephonic exit interview was conducted with April Taylor. A hard copy of the report and appeal rights was emailed. Staff was instructed to sign the LIC 9099 reports and return to LPA.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2020

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20190828112905

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: PARKVIEW OF GLENDALE	FACILITY NUMBER: 197609084
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/09/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/09/2020 Section Cited HSC 1569.655(a)	1 2 3 4 5 6 7	§1569.655(a) Increase in fee rates for elderly residents; 60 days’ written notice stating amount of and reasons for increase; application of section. (a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident.	1 2 3 4 5 6 7	Administrator shall review admissions agreement California Code of Regulations 87507, as well as Health and Safety Code 1569.655. On August 23, 2020 a 2nd notice that superseded the invalid 1st notice was issued to residents. POC has been cleared.
	8 9 10 11 12 13 14	This requirement was not met by evidence of: Based on review of facility documents i.e. 2 notices issued "Addendum to Admission Agreement" & "Notice of Increased Basic Monthly Fee", and admission agreements licensee failed to issue proper notification. The reason for rate increase was not stated on the 1st notice issued to residents. This poses a potential health and safety 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: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2020

LIC9099 (FAS) - (06/04)

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