198602564-11-13-2023-28-AS-RORN-CZLM7P-20240118082148

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602564
Report Date: 11/13/2023
Date Signed: 11/13/2023 03:11:09 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
10/05/2021 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211005163109

FACILITY NAME:	ROYAL VISTA SAN GABRIEL		FACILITY NUMBER:	198602564
ADMINISTRATOR:	REGINA AGUILAR-GUEVARA		FACILITY TYPE:	740
ADDRESS:	901 W SANTA ANITA ST		TELEPHONE:	(626) 289-8889
CITY:	SAN GABRIEL	STATE: CA	ZIP CODE:	91776
CAPACITY:	100	CENSUS: 46	DATE:	11/13/2023
		UNANNOUNCED	TIME BEGAN:	01:37 PM
MET WITH:	Nelida Arlante, Administrator		TIME COMPLETED:	03:12 PM

ALLEGATION(S):

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Facility staff engaged in financial abuse of resident(s).

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint visit to finalize complaint and deliver findings on the above allegation. The purpose of the visit was explained to Wellness Nurse Elizabeth Contreras. Administrator Nelida Arlante.

The investigation consisted of: On 10/12/2021, staff (S2- S6) and residents (R1 - R3) were interviewed. Staff (S1) was not interviewed because staff (S1)/Resident Care Coordinator was placed on a suspension leave on 9/29/2021 pending investigation. The following documents were reviewed/obtained: Resident (R1's) Identification and Emergency Information, Physician Report, Admission Agreement, Assisted Living Waiver Individual Service Plan, and Client/Residential Personal Property and Valuables documents, copy of staff (S1's) job description and Employee Counseling Report, resident roster and LIC 500 Personnel Report. In addition, a total of 30 resident Authorization for Credit Card Use documents were obtained. On 10/26/2021, LPA interviewed four (4) resident authorized representatives. During today's visit, residents (R4 - R6) were interviewed.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

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-20211005163109

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: ROYAL VISTA SAN GABRIEL	FACILITY NUMBER: 198602564
	VISIT DATE: 11/13/2023

NARRATIVE

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Allegation: Facility staff engaged in financial abuse of resident. The complaint alleges that resident(s) were financially abused by Administration staff. It is alleged that former staff (S1)/Resident Care Coordinator used resident (R1's) debit card and charged approximately $800.00. The first fraudulent activity noted in R1's debit card was in July 2021. A new debit card was reordered. However, in August 2021 new fraudulent charges were caught by the bank. Based on record review and interviews conducted the findings indicate that staff (S1) had access to confidential credit card information via "Authorization for Credit Card Use" forms on file. In July 2021, resident (R1) asked staff (S1) to purchase a watch in the amount of $125.00 from Nordstram Rack. Staff (S1) used their own credit card and took R1's money. However, several weeks later R1 had not received the watch and asked S1 to cancel the order. Staff (S1) promised to return the money to R1, but did not. During July 2021- September 2021, R1's bank card was charged for items not purchased by the resident. Resident (R1) occasionally asked staff to assist with purchases. At least two (2) staff., staff (S1) and staff (S4) had access to R1's bank debit card. When the alleged financial abuse incident were occurring the facility did not have an Administrator. The Resident Care Coordinator was appointed by licensee to be in charge of the facility without being qualified as an Administrator.

According to staff interviews, in September 2021 the facility received several phone calls from three (3) different resident's family members reporting fraudulent charges on the resident's debit bank cards. The Resident Care Coordinator (Staff 1) at that time was the only person responsible for charging the resident's monthly rent by accessing "Authorization for Credit Card Use" forms that have credit card information. A total of four (4) authorized representatives were interviewed. Two (2) out of the four (4) stated that their loved ones were overcharged rent fees in their bank cards. One resident was overcharged from January 2020- July 2020. The resident is part of the ALW program, and they confirmed the over charges were paid out from the resident's bank account. The Assisted Living Waiver program notified the authorized representative that facility staff were not billing correctly. Another resident was to be reimbursed money and the amount was not reimbursed as of 10/2021.

****Narrative continues next page.*****

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20211005163109

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: ROYAL VISTA SAN GABRIEL	FACILITY NUMBER: 198602564
	VISIT DATE: 11/13/2023

NARRATIVE

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Staff (S1) was not interviewed because they were suspended and terminated after facility conducted an internal investigation. Staff (S2 - S6) denied engaging in financial abuse of residents. However, two (2) out of the five (5) staff interviewed stated they suspected staff (S1) engaged in financial abuse of residents. Resident (R1) stated that staff (S1) and other staff in the facility were given the bank card and PIN number to make a gas purchase and snack purchases at 7 eleven, but never for Chipotle, Uber rides, Amazon, or Instacart. R1 stated that fraudulent charges were noted after giving the bank card PIN to staff. A total of six (6) residents were interviewed. Resident (R2) stated that in September 2021 their monthly rent was charged twice, and they notified staff (S1). Resident (R4) stated that concert tickets were purchased with the credit card on file, and the only staff that had access to their credit card was staff (S1). There is sufficient evidence to corroborate the allegation.

Licensee is to furnish a plan to the Regional Office on staff responsibilities and protocols for handling resident's money and accessing confidential credit card information. In addition, all staff shall be retrained on facility policy in reference to taking money and bank cards/PINs from residents.

Based on record review and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 8, Article 08 is being cited. See attached LIC 9099D.

Exit interview was conducted with Nelida Arlante. A copy of the appeal rights and report was issued.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20211005163109

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: ROYAL VISTA SAN GABRIEL	FACILITY NUMBER: 198602564
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/20/2023 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	Additional Personal Rights of Residents in Privately Operated Facilities: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met evidenced by:	1 2 3 4 5 6 7	Facility shall submit proof of: 1. Written POC that includes the job description of staff that are responsible for handling resident's money and accessing confidential credit card information. 2. Proof of staff retraining on facility policy against taking money, bank cards/PINs from residents and regulation 87468.2.
	8 9 10 11 12 13 14	Based on record review and interviews conducted, the findings indicate that S1 made unauthorized charges totaling approximately $800.00 by using R1's bank card/PIN for online purchases that were never received by R1, and charging concert tickets on R4's card. This poses an immediate and health and safety risk to persons in care.	8 9 10 11 12 13 14
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	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: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

LIC9099 (FAS) - (06/04)

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