198203965-6-20-2023-11-AS-JHAD-CUQRCP-20230815125441

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198203965
Report Date: 06/20/2023
Date Signed: 06/20/2023 12:08:38 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/11/2023 and conducted by Evaluator Jeremiah Randle

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230111150937

FACILITY NAME:	VILLA CHRISTA		FACILITY NUMBER:	198203965
ADMINISTRATOR:	ARLENE FELICIANO		FACILITY TYPE:	740
ADDRESS:	16421 CHANERA AVE		TELEPHONE:	(310) 719-8997
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90504
CAPACITY:	6	CENSUS: 5	DATE:	06/20/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Maria Agnes Torres Care Giver		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility staff did not issue a proper refund.

INVESTIGATION FINDINGS:

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On 6/20/2023 Licensing Program Analyst (LPA) Jeremiah Randle conducted a subsequent unannounced complaint investigation visit to deliver findings at the facility listed above. LPA identified himself and discussed the purpose of the visit and the elements of the allegation with Administrator Arlene Feliciano via telphone call.

The Investigation Consisted of the Following:

On 1/18/2022 LPA Randle conducted a tour of physical plant, interviewed Staff 1 (S1), and reviewed facility files for resident R1. LPA requested and received the following documents from the facility: Admissions Agreement, House Rules, Physicians Report /Medical Records, Client Roster, Staff Roster, Needs and Services Plan, Functional Capability Assessment, SIR’s/SOC 341, staff / nursing notes, death report, and resident financial detail statements including any other pertinent documents.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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 11-AS-20230111150937

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA CHRISTA	FACILITY NUMBER: 198203965
	VISIT DATE: 06/20/2023

NARRATIVE

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Investigation Revealed the following.

Regarding Allegation: Authorized representative was not provided a refund.

It was alleged authorized representative was not provided a refund for pre-admission fees. On 1/18/2023 LPA Jeremiah Randle conducted an interview with facility administrator Arlene Feliciano (S1). Arlene Feliciano admitted a refund was not provided to the responsible party of R1 for any part of the pre-administrative fee. Per Title 22 Preadmission fees shall be refunded according to the following conditions: A 100 percent refund of a preadmission fee shall be provided to an applicant or the applicant’s representative if: The licensee fails to provide full written disclosure of preadmission fee charges and refund conditions. On 1/18/2023 LPA reviewed facility files and R1's admissions agreement and no clause for refunds are included.

Based on interviews and records reviewed, the preponderance of evidence standard has been met. LPA finds the alleged violation did occur; therefore, the allegation is SUBSTANTIATED.

The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. This poses a potential risk to Health and Safety or personal rights to clients/residents in care.

Exit interview held with Administrator. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230111150937

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA CHRISTA	FACILITY NUMBER: 198203965
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/20/2023 Section Cited CCR 87507g(5)(A-E)	1 2 3 4 5 6 7	Admissions Agreement Refund conditions. (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death... this requirement is not met as evidenced by	1 2 3 4 5 6 7	Administrator to submit proof of payment back to authorized representative for Resident 1 by POC due date 6/23/23 . Administrator to provide the department with a copy of Admissions agreement that complies with Title 22 (especially pre-admission refund section cited)6/30/23.
	8 9 10 11 12 13 14	Based on interviews conducted and information gathered the licensee failed to return advanced monthly fees to residents resopnsible party which had been entrusted to the licensee and not surrendered to the residents responsible party.	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: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

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