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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197690045
Report Date: 04/29/2022
Date Signed: 04/29/2022 03:17:58 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/01/2021 and conducted by Evaluator Ashley Smith
COMPLAINT CONTROL NUMBER: 29-AS-20211001081014
FACILITY NAME:ELEVATION BEHAVIORAL HEALTHFACILITY NUMBER:
197690045
ADMINISTRATOR:LORI SCOTTFACILITY TYPE:
772
ADDRESS:3855 BRUNSTON COURTTELEPHONE:
(818) 877-0934
CITY:WESTLAKE VILLAGESTATE: CAZIP CODE:
91362
CAPACITY:6CENSUS: 6DATE:
04/29/2022
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Alicia KennedyTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Licensee failed to correctly charge clients for services as described in the admissions agreement
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ashley Smith arrived at unannounced for a subsequent complaint visit. The LPA met with House Lead Christina Hemmingway and explained the reason for the visit.

During the initial visit on 10/05/2021, the LPA conducted a tour at 12:51 p.m., interviewed staff at 1:27 p.m. and 1:35 p.m., and requested documents. On 3/23/2022, the LPA requested documents and interviewed staff at 11:22 a.m., 11:43 a.m., 11:54 a.m., 12:21 p.m., 2:40 p.m. and 3:10 p.m. Today, the LPA interviewed staff at 12:56 p.m., 1:21 p.m. and 1:41 p.m., audited files alongside staff, and interviewed a client at 1:16 p.m.

Regarding the allegation, it was alleged that the license was incorrectly charging clients an out-of-pocket rate to stay at this facility, along with billing their insurance. Interviews and record review revealed that clients can either be considered private pay, insurance pay, or ‘hybrid’ pay, in which 'hybrid' indicates that a client’s admission fee is covered both by insurance and an out-of-pocket cost. Yet, the out-of-pocket cost would be the cost of their deductible.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
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 3
Control Number 29-AS-20211001081014
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ELEVATION BEHAVIORAL HEALTH
FACILITY NUMBER: 197690045
VISIT DATE: 04/29/2022
NARRATIVE
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Interviews confirmed that as every insurance policy is different, every client would have to meet their deductible prior to insurance covering the full cost of admission. As such, a review of Admission Agreements and insurance verification forms confirmed that clients have varying deductibles to meet. If a client has not met their deductible prior to being admitted to this facility, clients are responsible for paying their deductible before insurance covers the remaining cost. In reviewing separate insurance verification forms, depending on whether a client has met a portion of their deductible, a client may only be responsible for $500 of their entire stay at this facility. However, there are other clients that had not met their deductible, thus that client may have been responsible to pay $4000, as they had a larger deductible to meet. Comparatively, if a client has met their deductible for the year, insurance could cover the full cost of their stay at this facility.

However, interviews and record review confirmed that clients would have to pay out of pocket for additional services. Additional services would include acupuncture, massages, hypnotherapy, private yoga, and so on. For example, if a client is admitted on 3/1/2022 and declines additional services, then it is documented on the Admission Agreement as a denial of additional services. However, if that client decided to partake in a session after signing their admissions agreement and it is not covered in their treatment plan, then they would have to pay for the service out of pocket. However, the client directly pays the provider of the additional service, not the licensee. The LPA reviewed audited records and invoices alongside staff and was unable to uncover any inconsistencies or errors. Lastly, the cost for each additional service is available in the signed admission agreement, and clients have to sign a ‘service upgrade request’ form prior to utilizing an additional service.

Based on the information obtained during the course of the investigation, there is insufficient evidence to support the claim that the licensee failed to correctly charge clients for services as described in the admissions agreement. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3