198204069-5-17-2024-11-AS-SCIS-D5J23P-20240522170240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204069
Report Date: 04/08/2024
Date Signed: 05/17/2024 12:01:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/09/2022 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20221109093215

FACILITY NAME:	SUNRISE ASSISTED LIVING OF SANTA MONICA		FACILITY NUMBER:	198204069
ADMINISTRATOR:	GOLIA, ALBERTO		FACILITY TYPE:	740
ADDRESS:	1312 15TH ST		TELEPHONE:	(310) 899-1976
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90404
CAPACITY:	100	CENSUS: 74	DATE:	04/08/2024
		UNANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:	Henry Reyes, Business Office Manager		TIME COMPLETED:	10:40 AM

ALLEGATION(S):

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Staff is overcharging resident for services.
Staff did not provide resident with itemized list of fees.

INVESTIGATION FINDINGS:

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*This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 4/8/24.

On 4/8/24 Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced subsequent visit to the address listed above. LPA arrived and spoke to Business Office Manager, Henry Reyes and the purpose of the visit was discussed. LPA was granted access to the facility.

The investigation consisted of the following: On 03/06/24 LPA Shirley conducted interviews with both staff and residents, a review of Staff roster, Resident roster, Resident files, Admission Agreements, Summary of Fees and conducted a tour of the facility for a health and safety check.

The investigation revealed the following:

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024

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 11-AS-20221109093215

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SUNRISE ASSISTED LIVING OF SANTA MONICA	FACILITY NUMBER: 198204069
	VISIT DATE: 04/08/2024

NARRATIVE

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Allegation: Staff is overcharging resident for services

It is being alleged that staff is overcharging resident for services. During document review, LPA first observed the resident roster and did not find the resident listed. LPA did not observe R1 at the facility. LPA learned that R1 is no longer residing at Ivy Park At Santa Monica, as there was no record, file nor bills for this resident. This facility has undergone new ownership and facility did not have records for this resident who resided under the former owner Sunrise Assisted Living of Santa Monica. LPA learned that R1 was placed in hospice and is now residing at a board and care called Beverly Wood.

On 3/06/24, LPA Shirley interviewed staff 1 through staff 6(S1-S6). LPA asked staff, does this facility overcharge residents for services previously agreed upon during the admission process. Of those interviewed, 3 out of 6 stated no. LPA Shirley interviewed resident 1 – resident 6 (R1-R6). LPA ask residents if they had been overcharged for services other than what was agreed upon. Of those interviewed, 4 out of 5 answered no. R1 was not available for interview. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation: Staff did not provide resident with itemized list of fees

It is being reported that this facility does not provide residents with an itemized list of charges. On 3/06/24, LPA Shirley toured the facility and found no present or imminent threat to the health and/or safety of the residents in care. LPA Shirley reviewed resident files and billing. During file review and interviews, LPA found that prospective residents are provided itemized list of charges that facility anticipates will be charged for services rendered. If it is determined that the resident needs a higher level of care, there is an assessment and staff will discuss the needs of the resident with the families or responsible parties before the resident is charged the additional fees. LPA Shirley reviewed resident’s Admission Agreements and observed the Summary of Fees for services and programs offered.

On 3/06/24, LPA Shirley interviewed staff 1 through staff 6(S1-S6). LPA asked staff, when an admission agreement is signed, is there an itemized list of charges provided to families for services that will be rendered. Of those interviewed, 3 out of 6 answered yes. LPA Shirley interviewed resident 1 – resident 6 (R1-R6). LPA ask, when you were admitted to Sunrise Assisted Living, were you provided an itemized list of charges for services that will be rendered during your stay. Of those interviewed, 2 out of 5 answered yes. R1 was not available for interview. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted and a copy of the LIC 9099 was provided to Business Office Manager, Henry Reyes.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024

LIC9099 (FAS) - (06/04)

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