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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603276
Report Date: 07/20/2023
Date Signed: 07/20/2023 11:36:45 AM

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
06/29/2023 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20230629151114
FACILITY NAME:YEARLING BOARD AND CAREFACILITY NUMBER:
198603276
ADMINISTRATOR:TANGONAN, MARIA ISABELFACILITY TYPE:
740
ADDRESS:11439 YEARLING CIRCLETELEPHONE:
(562) 307-7668
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:6CENSUS: 6DATE:
07/20/2023
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Administrator Maria TangonanTIME COMPLETED:
11:55 AM
ALLEGATION(S):
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Staff did not provide proper notification to increase resident's rates.
Staff are charging resident for unnecessary fees.
INVESTIGATION FINDINGS:
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On 07/20/2023 at 9:31 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent 10-day complaint visit, to deliver findings. LPA met with staff (S1) Manuel Torres who contacted the administrator. At 9:50 (Administrator) Maria Tangonan called and LPA explained the reason for the visit. Staff Leonida Namuag arrived at 10:45 a.m.

During the initial visit on 7/6/2023, LPA toured the facility with the Administrator. LPA obtained resident roster, staff roster, staff schedule, R1 admissions agreement, R2 admissions agreement, R1 Needs and services plan dated 6/09/22 and 6/22/2023, R1 physicians’ report, and letter of fee increase. LPA also interviewed: Administrator and a total of two (2) staff who shall be referred to as S1, and S2. LPA interviewed a total of three (3) residents who shall be referred to as: R1 through R3. LPA attempted to interview R4 through R6, but due to communication limitation LPA was unable to conduct the interview. LPA also interviewed family member of R4.
Report continued on 9099c
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
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 5
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
06/29/2023 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20230629151114

FACILITY NAME:YEARLING BOARD AND CAREFACILITY NUMBER:
198603276
ADMINISTRATOR:TANGONAN, MARIA ISABELFACILITY TYPE:
740
ADDRESS:11439 YEARLING CIRCLETELEPHONE:
(562) 307-7668
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:6CENSUS: 6DATE:
07/20/2023
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Administrator Maria Tangonan TIME COMPLETED:
11:55 AM
ALLEGATION(S):
1
2
3
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9
Staff did not provide resident with a break down of fees due to rate increase
Staff are not able to meet resident's needs due to being short staffed.
INVESTIGATION FINDINGS:
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On 07/20/2023 at 9:31 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent 10-day complaint visit, to deliver findings. LPA met with staff (S1) Manuel Torres who contacted the administrator. At 9:50 (Administrator) Maria Tangonan called and LPA explained the reason for the visit. Staff Leonida Namuag arrived at 10:45 a.m.

During the initial visit on 7/6/2023, LPA toured the facility with the Administrator. LPA obtained resident roster, staff roster, staff schedule, R1 admissions agreement, R2 admissions agreement, R1 Needs and services plan dated 6/09/22 and 6/22/203, R1 physicians’ report, and letter of fee increase. LPA also interviewed: Administrator and a total of two (2) staff who shall be referred to as S1, and S2. LPA interviewed a total of three (3) residents who shall be referred to as: R1 through R3. LPA attempted to interview R4 through R6, but due to communication limitation LPA was unable to conduct the interview. LPA also interviewed family member of R4.
Report continued on 9099c
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
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 5
Control Number 28-AS-20230629151114
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: YEARLING BOARD AND CARE
FACILITY NUMBER: 198603276
VISIT DATE: 07/20/2023
NARRATIVE
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The investigation reveals the following: Regarding " Staff are not able to meet resident's needs due to being short staffed.", it is alleged that the facility wants to evict R1 due to being short staffed. During the tour LPA observed 2 staff on duty. The Administrator denied the allegation stating they have 2 staff working during the day and 1 night staff. LPA observed staff schedule and confirmed administrators interview. 2 out of 2 staff stated the facility have 2 staff working during the day and 1 night staff. 3 out of 3 residents stated the facility has 2 or more staff during the day and 1 night staff. Family member for R4 stated during visitations they always observe 2 staff. Facility member for R1 stated the facility has not given a formal eviction notice but stated they are short of male staff and will not be able to continue caring for R1.

The investigation reveals the following: Regarding " Staff did not provide resident with a breakdown of fees due for rate increase.", it is alleged that the facility did not provide a proper breakdown of fees before rate increase. The administrator denied the allegation stating they provided all responsible parties with a breakdown of fee increase. LPA reviewed the document provided and confirmed the breakdown of the fees before rate increase. 2 out of 2 staff stated they are not involved in the financial aspects of the facility. 3 out of 3 residents stated their family members handle their finances. Family member of R4 stated they are unsure if they received a breakdown of fees. Family member of R1 stated they did not receive a breakdown of rates.

Based on LPA's interviews, investigation revealed: Although the allegation may have happened or is 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 with Leonida Namuag and a copy of this record provided.

SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20230629151114
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: YEARLING BOARD AND CARE
FACILITY NUMBER: 198603276
VISIT DATE: 07/20/2023
NARRATIVE
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 The investigation reveals the following: Regarding " Staff did not provide proper notification to increase resident's rates.", it is alleged that the facility notified the responsible parties through text. The Administrator denied the allegation stating the families received a 30-day notice and was provided with written notice. 3 out of 3 residents interviewed stated their family members handle their finances. LPA interviewed a told of 2 family members who stated they received a 30-day notice before the rate increased. Per the health and safety code the facility is required to gave no less than 60 days’ notice for a rate increase

The investigation reveals the following: Regarding " Staff are charging resident for unnecessary fees.", it is alleged that the facility is going to increase fees during months of major holidays. The Administrator confirmed the allegation stating the increase is used to pay staff time and a half during the holidays. 3 out of 3 residents interviewed stated their family members handle their finances. LPA interviewed a told of 2 family members who confirmed the allegation stating the rate increases during the holidays and decreases after the holiday. Documentation reviewed confirmed the allegation.

Based on LPA observation, interviews and file review, the preponderance of evidence standard has been met, therefore, the above allegations is found to be SUBSTANTIATED. California Code of Regulation, Title 22 are being cited on the attached LIC9099D.

Exit Interview Conducted with administrator/ Appeal Rights Provided / A Copy of the Report Issued.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20230629151114
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: YEARLING BOARD AND CARE
FACILITY NUMBER: 198603276
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2023
Section Cited
HSC
1569.655(a)
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1569.655 (a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives ...
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The Licensee will ensure the facility provides proper notification of there rate increase and review health and safety code 1569.655 by POC due date.
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This requirement is not being met as evidenced by : Facility administrator confirmed the residents resonsible parties was given a 30 days notice, which poses/posed a potential health, safety or personal rights risk to
persons in care.
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Type B
08/04/2023
Section Cited
HSC
1569.655(b)
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1569.655(b) No licensee shall charge nonrecurring lump-sum assessments. The notification requirements contained in subdivision (a) shall apply to increases specified in this subdivision. For purposes of this subdivision, "nonrecurring lump-sum assessments" mean rate increases due to unavoidable and unexpected costs that financially obligate the licensee. In lieu of the lump-sum payment, all increases in rates shall be to the monthly rate amortized over a 12-month period. The prohibition against a lump-sum assessment shall not apply to charges for specific goods or services provided to an individual resident.
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The Licensee will ensure they do not charge non reaccurring lump sum and review health and safety code 1569.655 by POC due date.
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This requirement is not being met as evidenced by : Facility administrator confirmed that they requires residents to pay holiday pay only during the holidays, which poses/posed 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.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5