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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204758
Report Date: 05/18/2022
Date Signed: 05/21/2022 07:21:29 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/13/2022 and conducted by Evaluator Jey Cardenas
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220113153405
FACILITY NAME:BROOKDALE OCEAN HOUSEFACILITY NUMBER:
198204758
ADMINISTRATOR:PARK, THOMASFACILITY TYPE:
740
ADDRESS:2107 OCEAN AVETELEPHONE:
(310) 399-3227
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY:150CENSUS: 85DATE:
05/18/2022
UNANNOUNCEDTIME BEGAN:
09:49 AM
MET WITH:Joshua CastilloTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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A resident was charged for services not received
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Jey Cardenas conducted subsequent complaint investigation visit to the above facility to continue investigation. LPA met with Associate Executive Director, Joshua Castillo and conducted covid-19 risk assessment, facility has one positive covid-19 case at this time. LPA explained the purpose of today’s visit.

Investigation consisted of the following: Initial 10 day visit was conducted on 1/21/22 LPA Cardenas interviewed Health & Wellness director, Amanda Monroy. On 5/18/22 LPA interviewed Joshua Castillo in person and Former Executive Director, Thomas Rekowski via telephone. LPA obtained and reviewed Resident#1s (R1) admission agreement, physician report, Account History Report, Residency Application, and Preplacement appraisal.
-Regarding allegation: A resident was charged for services not received- It is being alleged that on 5/27/2021 agreement was made with former Executive Director, Thomas; that R1 was not going to move in to the facility until an approval from Long term Care insurance claim was obtained.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jey CardenasTELEPHONE: (323) 383-8188
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
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 2
Control Number 11-AS-20220113153405
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: BROOKDALE OCEAN HOUSE
FACILITY NUMBER: 198204758
VISIT DATE: 05/18/2022
NARRATIVE
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(cont' pg 2)
Thomas was made aware that R1 was collecting SSI and didn’t have the funds to pay facility fees without insurance coverage. On 5/31/21 admission agreement was signed. On 7/28/2021 R1 moved in to facility even though resident hadn’t received approval from insurance company. Facility assure R1 that insurance company would be approved and costs would be covered. On 9/3/2021 resident received insurance claim denial notice. R1 has since been billed and is now responsible for repayment from 5/31/21 to 09/15/21 although R1 didn’t move into the facility until 07/28/21.

On 5/18/22 LPA Cardenas interviewed Thomas via telephone regarding allegation. He indicates that Long Term Care insurance claim can only be filed until resident is admitted to a care facility. Facility doesn’t conduct income verifications, R1 disclosed being employed and having savings, but never being on SSI. Facility doesn’t accept SSI eligible recipient. Facility is private pay and only accepts personal checks. R1 was working with a referral agent, not associated to the facility, who was responsible for reviewing residents’ budget and going over facility costs. Resident was presented with the option to move into the facility and was never pressured. Worst case scenarios were discussed with R1 such as insurance denial. R1 told Thomas this was not an issue because resident was already pre-approved and was formally going through the process. Thomas encourage R1 to reach out to insurance company to iron out the terms and conditions. Facility doesn’t get involved with insurance claims. R1 was told that per admission agreement, resident was taking financial responsibility as of 5/31/21 and payments would be expected thereon. Thomas states that R1s insurance claims was denied due to physician submitted paperwork to residents insurance determining that R1 didn’t need to live at a facility due to resident was self-sufficient due to still working and driving.

On 5/18/22 LPA Cardenas interviewed Joshua Castillo who indicate that Facility doesn’t not conduct a income verification regarding residents source of income. Facility takes resident self-attestation that they have the funds to cover the cost. It is ultimately the residents decision to move in and make arrangements to ensure they have sufficient funds to cover cost.

On 5/18/22 LPA Cardenas reviewed R1’s admission agreement with Joshua to clarify charges. Per admission agreement: Rate: you agree to pay the basic service rate and, if applicable the Personal service rate as indicated in Exhibit A. We do not accept SSI/SSP eligible residents for admission to the community. Per Exhibit A Schedule of services and rates: “I agree to above scheduled of services and rates to commence as of May 31, 2021. I have reviewed Exhibit X, selected services listed…I agree that I will be charged each time I utilize one of those services at the community. Admission agreement is signed by R1 dated 5/31/2021. R1 was considered a community member as of that date and charges started to accrue thereon.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies cited, Exit Interview conducted, and report given facility representative.

SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jey CardenasTELEPHONE: (323) 383-8188
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC9099 (FAS) - (06/04)
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