197801052-5-4-2023-28-AS-RORN-CSBUHL-20230530153603

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197801052
Report Date: 05/04/2023
Date Signed: 05/04/2023 03:52:44 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
04/21/2022 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220421101842

FACILITY NAME:	ATRIA RANCHO PARK		FACILITY NUMBER:	197801052
ADMINISTRATOR:	ALONDRA FUENTES		FACILITY TYPE:	740
ADDRESS:	801 CYPRESS WAY		TELEPHONE:	(626) 339-5426
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	0	CENSUS: 0	DATE:	05/04/2023
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Alondra Fuentes - Former Executive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility did not roll over residents payment to the new owners resulting in incorrect billing.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced subsequent complaint visit to determine the validity of the above-mentioned allegation. LPA met with Alondra Fuentes (Former Executive Director) and explained the reason for the visit.

The investigation consisted of the following: On 04/29/2022, LPA Mora conducted an initial complaint visit and obtained copies of Resident 1 (R1) admission agreement, email regarding rent payment, and R1's account ledger. On 05/04/2023, LPA conducted a collateral visit to the new facility to interview the new owner's Executive Director and Business Office Manager and obtained a copy of R1's ledger. On 05/04/2023, LPA conducted a second collateral visit at another facility to interview the Former Executive Director of Atria Rancho Park.

The investigation revealed the following: regarding the allegation "facility did not roll over residents payment to the new owners resulting in incorrect billing”, it is alleged that R1's family member paid Atria Rancho Park 3 months in advance (January, February and March of 2022). However, when the change of ownership happened the funds were not transferred to the new owner. (Continue to LIC 9099C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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-20220421101842

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ATRIA RANCHO PARK	FACILITY NUMBER: 197801052
	VISIT DATE: 05/04/2023

NARRATIVE

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Interviewed with the new owner's Executive Director and Business Office Manager revealed that they took over the facility effective January 2022. On 02/23/2022 and 03/07/2022, Atria Rancho Park wired them two payments to apply to R1's account. These two payments were made by R1's family member on 12/29/2021 and were for the month of January 2022. They claim that they did not receive any other payments from Atria Rancho Park and don't know if they attempted to wire additional payments for February or March 2022. They provided a copy of an email to the LPA and the email is a conversation between Atria Rancho Park billing supervisor and R1's family member. This email is dated 04/21/2022 and the billing supervisor states in that email that Atria Rancho Park received a payment from R1's family member on 02/02/2022 and that they have been trying to wire this payment to the new owner of the facility several times, but they have yet to receive correspondence from the new owners. Therefore, they issue a refund to R1's family member on 04/21/2022. On 05/04/2023, the LPA met with Atria Rancho Park's Former Executive Director during a collateral visit at another facility and she contacted Atria's billing department. The billing department responded with proof that they have already refunded R1's family member on 04/21/2022. However, LPA did not receive any proof that Atria attempted to wire the funds to the new owner between February and March 2022.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiency is being cited according to Title 22, Division 6, Chapter 8. Refer to LIC 9099-D.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220421101842

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ATRIA RANCHO PARK	FACILITY NUMBER: 197801052
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/04/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/11/2023 Section Cited CCR 87217(i)	1 2 3 4 5 6 7	87217 - Safeguards for Resident Cash, Personal Property, and Valuables (i) Upon discharge of a resident, all cash resources....which have been entrusted to the licensee shall be surrendered to the resident, or his responsible person. A signed receipt shall be obtained.	1 2 3 4 5 6 7	Facility will ensure that Title 22 Regulation Section Code 87217 is met at all times. Additionally, the facility will submit a statement stating that they understand and will comply with this Regulation Section Code to CCLD by 05/11/2023.
	8 9 10 11 12 13 14	This requirement was not met evidenced by: Based on records review and interviews, the facility did not wire R1's monthly rent in a timely manner to the new owner of the facility, which poses a potential health and safety risk to persons 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: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC9099 (FAS) - (06/04)

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