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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602608
Report Date: 02/01/2024
Date Signed: 02/01/2024 02:53:37 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
06/23/2022 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220623080038
FACILITY NAME:GROVE AT CERRITOS, THEFACILITY NUMBER:
198602608
ADMINISTRATOR:BRITTNEY BUCHANNANFACILITY TYPE:
740
ADDRESS:11000 NEW FALCON WAYTELEPHONE:
(562) 865-9500
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:163CENSUS: 135DATE:
02/01/2024
UNANNOUNCEDTIME BEGAN:
02:09 PM
MET WITH:Laura Rodriguez TIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Licensee did not ensure pre-admission appraisal was done correctly
Facility did not issue the correct refund amount
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wong conducted a “Subsequent” visit to ascertain additional information regarding the above-mentioned allegation(s) and for the purpose of rendering the findings. LPA met with Staff #1 Randyl Lowe (Receptionist) who allowed entry into the facility and was later met by Administrator Laura Rodriguez who assisted with the visit.

The investigation consisted of the following: On 12/20/22, LPA Wong interviewed the administrator, 4 staff (S1-S4) and 13 residents (R2-R14) and obtained the current staff roster and resident roster. On 6/28/2022, Licensing Program Manager (LPM) Sicairos conducted an initial 10-day complaint and obtained copies of Staff & Resident Rosters, reviewed Former Resident #1 (FR1) file, and obtained copies of Identification and Emergency Information Sheet, Physician's Report, Admission Agreement, Service Plan, Progress Notes, Resident Appraisal, Admission Orders, and Resident Detail Ledger. LPA interviewed Ms. Mosalla and Staff #1 (S1).
(See LIC 9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
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 28-AS-20220623080038
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: GROVE AT CERRITOS, THE
FACILITY NUMBER: 198602608
VISIT DATE: 02/01/2024
NARRATIVE
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The investigation revealed of the following: Allegation#1 “Licensee did not ensure pre-admission appraisal was done correctly.” It is alleged that the facility told R1's family that R1 requires more care than the facility can provide and the facility told R1's family to hire an outside agency to provide additional care while the family is looking for a new care home for R1. LPA interviewed 13 residents and all denied the allegation and indicated the facility is able to provide the assistance that residents required and needed. LPA interviewed the staff and denied the allegation and stated before resident move in to the facility, the facility would complete a pre-appraisal assessment along with the primary care physician report and review resident’s medication and also see if resident is under fall risk or not. They would also complete a 30-day assessment after resident move in and communicate with the families and see if the resident required full assistance. Based on the documents reviewed, the facility completed the resident’s appraisal and a comprehensive health and service evaluation with needs and service plan for R1. The facility also assessed R1’s fall risk and the level of care. In addition, the facility tried to accommodate residents’ needs and let R1’s family stay with the resident during the transition period.

Allegation#2 "Facility did not issue the correct refund amount." It is alleged that R1 should have been refunded more than what the facility provided upon leaving the facility. LPA reviewed R1's financial records and conducted interviews with staff. R1's record review revealed that the facility charges a $3500 community fee. However, R1 received promotional offer which waived $2000 of that initial fee, therefore R1's family only paid a $1500 community fee upon moving in on 05/07/2022. The monthly charges for May 2022 was scheduled to be $3207, however R1 only lived at the facility for two weeks, therefore paid a prorated amount of $2762 for the month instead. Per the Admission Agreement signed by R1's family, they were entitled to an 80% refund of the community fee which equaled to $1193. In addition the facility agreed to provide a "miscellaneous fee" in the amount of $310 to R1's family which was not required per the Admission Agreement. In conclusion, R1's paid a total of $6707 but was refunded $4265. There was no evidence obtained during the investigation indicating that R1's family should have received a larger refund.

Based on statements and interviews conducted with staff and residents and documents reviewed, there was not enough supportive evidence to concur with the reported allegations. 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 allegations are UNSUBSTANTIATED.


Exit Interview Conducted. A copy of the report was provided to the Executive Director Laura Rodriguez.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC9099 (FAS) - (06/04)
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