197609638-9-19-2021-31-AS-NMAN-C72MUS-20210920095537

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609638
Report Date: 09/19/2021
Date Signed: 09/19/2021 03:11:48 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
07/27/2020 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20200727163912

FACILITY NAME:	PACIFICA SENIOR LIVING NORTHRIDGE		FACILITY NUMBER:	197609638
ADMINISTRATOR:	VILLASENOR, LISA		FACILITY TYPE:	740
ADDRESS:	8700 LINDLEY AVE		TELEPHONE:	(818) 886-5181
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	0	CENSUS: 81	DATE:	09/19/2021
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Francis Norberte, Memory Care Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff did not report suspected financial abuse

Resident illegally evicted

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced complaint visit to the facility. LPA met with Francis Norberte, Memory Care Director and discussed the purpose of the visit. Investigation of this complaint was initiated by LPA Naira Margaryan.

It was reported that R1 was the subject of financial exploitation in 2018. However, the report to other agencies was made in November 2019 and in July 2020.

During this investigation on 08/05/2020 at 11:30am LPA Margaryan spoke with the ED and she stated the following: ED indicated that she strongly believes the R1's responsible party was financially abusing R1. About suspected financial abuse Adult Protective Services (APS) and Long Term Care Ombudsman (LTCO) were notified more than once. R1's payments were made by the Long-Term care insurance. The checks were paid to R1's responsible party who failed to make payments to the facility. By November 2019, R1 had over $25,000 delinquent payments. See 9099C to continue

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2021

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-20200727163912

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: PACIFICA SENIOR LIVING NORTHRIDGE	FACILITY NUMBER: 197609638
	VISIT DATE: 09/19/2021

NARRATIVE

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ED made several attempts to reach R1's responsible party and received no response. First APS report ED made on November 2018. After serving 30- day eviction notice to R1's responsible party, ED filed SOC 341-suspected financial abuse to APS and LTCO. After initial report to APS, R1's responsible party made substantial payments and ED rescinded the 30-day eviction notice. APS and LTCO were notified. On 11/14/2019, ED made a second APS report and on 07/20/2020 a third report was filed with CCLD, APS, and LTCO. On 09/04/2020, ED received a call from R1's family member informing that she will be visiting the facility to bring the check.

On 09/04/2020, LPA Margaryan reviewed facility records including financial statements, copies of emails, and communication between ED and R1's responsible parties and copies of SOC 341s' sent to APS and LTCO. The information revealed from the documents verified the information received from ED. Based on interview and record review, there is no sufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

It was alleged that the facility had pursued an Unlawful Detainer naming resident #1 (R1), who has dementia and is unable to manage their finances as the defendant on the legal court document.

Resident #1 (R1)'s payment to the facility was made through the Long-Term Care Insurance. However, the checks were sent to R1's responsible party, who then forwards the payment to the facility. ED stated that R1 was never evicted from the facility. The 30-day eviction notice served due to delinquent payment was served to the residents responsible party on 09/13/2018. By 09/13/2018, R1 had over $25,000 in delinquent payment. ED made several attempts to reach R1's responsible party and received no response. On 11/13/2018 after ED served 30-day eviction notice to R1's responsible party. R1's responsible party responded and made an arrangement with the facility to make payments to cover for the delinquent amount. A 30-day eviction notice was rescinded. After a few months R1's responsible party stopped making payments again. On 03/03/2020 notice to pay or quit was served to R1's responsible party and on 03/11/2020 and Unlawful detainer was filed with the court. However, due to COVID-19, no further actions were taken to evict R1. ED continued making an effort to collect delinquent payments. On 09/04/2020, R1's family member contacted the facility to make a payment. On 09/04/2020 at 11:30am, LPA Margaryan reviewed various facility records including a copy of the 30-day eviction notice. The information revealed from the records verified the information received from the ED.
No relevant information was available to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2021

LIC9099 (FAS) - (06/04)

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