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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601845
Report Date: 07/13/2022
Date Signed: 07/13/2022 03:12:58 PM

Substantiated


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 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
07/12/2022 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220712103251
FACILITY NAME:A SPLENDOR LIVING - THE GLENDORA INCFACILITY NUMBER:
198601845
ADMINISTRATOR:CHRIS JENGFACILITY TYPE:
740
ADDRESS:452 SELLERS ST.TELEPHONE:
(626) 594-0152
CITY:GLENDORASTATE: CAZIP CODE:
91741
CAPACITY:34CENSUS: 9DATE:
07/13/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Jason ChuangTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility did not issue the agreed upon refund.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Jason Chuang and the reason for the visit was explained.
The purpose of the visit is to investigate the above allegation.
At today's visit at 10:10 AM Administrator was interviewed.
At 10:30 AM file for Resident R 1 was reviewed.
Copies of Admission Agreement, Physician's Report and Emergency ID page were submitted at today's visit.
In regards to the allegation Facility did not issue the agreed upon refund, based on interviews, file review and documentation letter that was submitted by family member for Resident R 1 which outlines that R 1's personal belongings were removed from the facility on 04/16/2022 and therefore the refund is $166.66 x 14 days= $2,333.24 based on payment of $5,000 paid monthly.
Interview with Administrator who confirmed that R 1's belongings were removed on 04/16/2022 and that the amount is owed for $2,333.24. Administrator did communicate with home office in San Francisco to issue the refund which he stated is common practice for all residents after leaving the facility.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
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 4
Control Number 28-AS-20220712103251
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: A SPLENDOR LIVING - THE GLENDORA INC
FACILITY NUMBER: 198601845
VISIT DATE: 07/13/2022
NARRATIVE
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Administrator did provide verification that payment was issued after the 15 days.
Check # 6102 was issued 07/07/2022.
LPA verified memo specifying check was issued.

Based on file review and interviews, conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 8 are being cited in the attached LIC 9099D.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 28-AS-20220712103251
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: A SPLENDOR LIVING - THE GLENDORA INC
FACILITY NUMBER: 198601845
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/20/2022
Section Cited
CCR
87507(g)(5)(c)
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87507 Admission Agreements: (g)... shall ..: (5) Refund conditions. (c) A refund of any fees paid in advance...after the resident’s personal property has been removed...shall be issued ... if ... resident paid the fees, ... within 15 days after the personal property is removed.
This requirement is not met as evidence by:
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Administrator will issue R1's responsible party a check for the amount of $2,333.24 and will submit proof of reimbursement to the department by POC due date.
Check # 6102 in the amount of $2,333.24 was issued 07/07/2022.

Deficiency cleared
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Based on file review and interview facility did not issue total refund amount to R1's responsible party. Total amount to reimburse is $2,333.24 to R1's responsible party which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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 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
07/12/2022 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220712103251

FACILITY NAME:A SPLENDOR LIVING - THE GLENDORA INCFACILITY NUMBER:
198601845
ADMINISTRATOR:CHRIS JENGFACILITY TYPE:
740
ADDRESS:452 SELLERS ST.TELEPHONE:
(626) 594-0152
CITY:GLENDORASTATE: CAZIP CODE:
91741
CAPACITY:34CENSUS: 9DATE:
07/13/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Jason ChuangTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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2
3
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9
Facility did not adhere to the terms of the Admission Agreement.
INVESTIGATION FINDINGS:
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In regards to the allegation Facility did not adhere to the terms of the Admission Agreement, based on interview with Administrator who stated he was not Administrator in May 2021 who communicated with family of R 1 about leaving early and the refund policy but did state that all residents would be reimbursed if they did leave facility early and they do adhere to the Admission Agreement.
Stated that it is common practice to issue refunds to all residents in a timely manner.
Stated that although refund is late for R 1 due to staff transition and communications with home office delaying the process, Check # 6102 was issued 07/07/2022.
LPA verified memo specifying check was issued.

Based on LPA's interviews conducted and records reviewed, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated.



Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4