198603162-4-18-2024-28-AS-RORN-D6DVH6-20240619162636

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 04/18/2024
Date Signed: 04/18/2024 02:24:59 PM

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 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
04/06/2023 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230406103046

FACILITY NAME:	WHITTIER GLEN ASSISTED LIVING		FACILITY NUMBER:	198603162
ADMINISTRATOR:	HIPOLITO, RHONWINN		FACILITY TYPE:	740
ADDRESS:	10615 JORDAN RD		TELEPHONE:	(562) 943-3724
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	93	CENSUS: 74	DATE:	04/18/2024
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Business Office Manager Lizbeth Acuna		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Staff does not provide a care plan for residents during pre-admissions.
Staff has forged resident's signatures.
Staff has overchaged residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos and Tyler Reyes conducted a subsequent complaint investigation visit for the allegation(s) listed above. LPA met with Business Office Manager Lizbeth Acuna and the purpose of the visit was discussed.

The following was conducted on initial visit on 4/11/23: LPA interviewed Staff #1-#2 (S1-S2). LPA toured the physical plant of the facility. LPA collected a copy of the staff and resident roster. LPA collected documents related Resident #1-6 (R1-R6) File such as the facesheet, needs and services plan, physicians report, admissions agreements and current ledgers.

As of todays visit, LPAs have interviewed R1-R5 and Resident #7 (R7). Resident #6 is no longer in the facility and unavailable for interview. LPA also collected related documents from R7's file. The investigation revealed the following:
Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

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-20230406103046

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: WHITTIER GLEN ASSISTED LIVING	FACILITY NUMBER: 198603162
	VISIT DATE: 04/18/2024

NARRATIVE

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In regards to the allegation "Staff does not provide a care plan for residents during pre-admissions" it is alleged that resident care plans are not created or provided for admitted residents. (4) of (4) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. The files for seven (7) residents in care were reviewed and the needs and services plans for each file was observed. LPA's observed the pre admission appraisals on file. Interviews show that staff will create the care plans with the residents and keep it on file upon admission. Staff interviewed explained that residents and their responsible parties are allowed to participate in creating the care plan and receive a copy if they choose too. The care plans are kept on file for each resident. The documents initially provided to residents and their responsible parties is the admissions agreement and all its attachments. The care plans are not part of the admissions agreement as they are a separate document, but is available upon request. There is no regulation requiring the facility to provide a care plan during the pre-admission of a resident. Based on interviews, file review, and observations; although the allegation 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 allegation is unsubstantiated.

In regards to the allegation "Staff has overcharged residents in care" it was alleged that the facility overcharged residents in millions of dollars with their level of care charges. (4) of (4) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Residents interviewed were aware of the amount they pay the facility monthly. No residents interviews stated to be overcharged for services provided and are informed with a notice when rent increases. Interviews show that the facility is a private pay facility that calculates each persons total monthly fee by adding the cost of room and board plus level of care (service). The level of care charge is discussed prior to admission with the resident and/or their responsible party prior to any contract agreements being signed. There are no changes done or charges made without notifying the residents or their responsible parties. File review shows that residents are provided notices of price increases throughout the years. Review of most recent ledgers for the residents matches with the most recent notices on file for the total monthly fees which includes the service level they are provided. Based on interviews, file review, and observations; although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Continued on LIC 9099-C

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230406103046

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: WHITTIER GLEN ASSISTED LIVING	FACILITY NUMBER: 198603162
	VISIT DATE: 04/18/2024

NARRATIVE

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In regards to the allegation "Staff has forged resident's signatures" it was alleged that resident signatures and initials were being forged by the staff. (4) of (4) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. LPAs showed residents their signatures from documents on file and they confirmed to believe it their own signatures. LPA was not provided with proof that signatures were being forged in facility documentation. Based on interviews, file review, and observations; although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit Interview conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

LIC9099 (FAS) - (06/04)

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