198603222-4-11-2023-28-AS-RORN-CRAVH7-20230427162640

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603222
Report Date: 04/11/2023
Date Signed: 04/11/2023 05:32:44 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
04/07/2023 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230407133907

FACILITY NAME:	WHITTIER PLACE SENIOR LIVING		FACILITY NUMBER:	198603222
ADMINISTRATOR:	WASHINGTON, MELANIE		FACILITY TYPE:	740
ADDRESS:	12315 BURGESS AVENUE		TELEPHONE:	(562) 777-1477
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90604
CAPACITY:	125	CENSUS: 57	DATE:	04/11/2023
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Kambria Wyatt		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Staff did not provide 60 day notice prior to increasing the resident's rate.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted a visit in response to the above allegation. On today's visit, LPA met with Business office manager, Kambria Wyatt who assisted with today's visit.

Regarding the allegation that staff did not provide 60 day notice prior to increasing resident #1s rate, the investigation consisted of review of resident #1's file, including admission agreement, and interview with Business office manager, Kambria Wyatt.

Ms. Wyatt stated that resident #1's level of care changed and that is why the facility increased resident #1's monthly rate. Ms. Wyatt stated that resident #1's family member was notified via telephone on 3/29/23, and an invoice dated 4/1/23. Ms. Wyatt stated that resident #1's family member was verbally advised of the change in level of care, however was not provided with a written notice.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

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-20230407133907

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 PLACE SENIOR LIVING	FACILITY NUMBER: 198603222
	VISIT DATE: 04/11/2023

NARRATIVE

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LPA reviewed invoice dated 4/1/23 provided to resident #1s family member. The invoiced did not provide a written detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code.

An exit interview was conducted with Ms. Wyatt. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20230407133907

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 PLACE SENIOR LIVING	FACILITY NUMBER: 198603222
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/11/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/10/2023 Section Cited HSC 1569.657(a)	1 2 3 4 5 6 7	For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges.	1 2 3 4 5 6 7	LIcensee will provide a credit to resident #'1s May 2023 statement in the amount of $2097.29. Licensee will provide proof of credit to LPA by POC due date.
	8 9 10 11 12 13 14	This requirement is not being met as evidenced by : LPA observed that Resident #1's rate was increased on April 1, 2023, and resident #1's family member was not provided a written notification of a rate increase due to a change in resident #'1s condition.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	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: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC9099 (FAS) - (06/04)

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