198603307-12-14-2023-28-AS-RORN-D27NK5-20240206093120

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603307
Report Date: 12/14/2023
Date Signed: 12/14/2023 12:42:19 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
12/11/2023 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231211121836

FACILITY NAME:	CLAREMONT PLACE		FACILITY NUMBER:	198603307
ADMINISTRATOR:	NICOLE VAZQUEZ		FACILITY TYPE:	740
ADDRESS:	120 WEST SAN JOSE AVENUE		TELEPHONE:	(909) 447-5259
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	93	CENSUS: 69	DATE:	12/14/2023
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Carla Mariano		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility did not issue a refund

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong conducted an initial 10 days complaint visit and ascertain information pertaining to the above-mentioned allegation(s) and to establish the validity of the complaint. LPA met with the receptionist Francis Clark and explained the reason of the visit. Later on, LPA met with the Executive Director Carla Mariano and assisted with the visit.

The investigation consisted of the following: On the above date, LPA interviewed seven (7) residents, administrator, business office manager and regional operation specialist via telephone. LPA also obtained documents included: Staff roster, resident roster and Resident#1 (R1) including face sheet, admission agreement, resident refund form, transaction report dated 12/1/23 to 12/31/23, 30 days notice to vacate, community fee receipt, community fee check# 794, R1 move in Pro-Rate worksheet and admission agreement.

(See LIC 9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

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-20231211121836

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: CLAREMONT PLACE	FACILITY NUMBER: 198603307
	VISIT DATE: 12/14/2023

NARRATIVE

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The investigation revealed of the following: Allegation "Facility did not issue a refund" LPA interviewed seven (7) residents and seven out of seven residents were denied the allegation and reported they never had any billing or refund issues with the facility. It was reported R1 admitted to the facility on 09/02/23 and R1's discharge date from the facility was on 11/3/23 with the 30 days notice but due to R1's account had some balance due and the facility was not able to close R1's account on the same day that R1 discharged. The facility attempted to contact R1's responsible party on 11/9/23 to discuss about R1's account balance due. The facility was not able to get any returned calls from responsible party until 11/30/23. During the conversation, facility staff advised R1's balance due and per R1's responsible party request which the refund to be issued the check in R1's responsible party name. The facility staff immediately processed the refund through the corporate office in Maryland and got approved on the same date. Although the facility is still waiting for the check number and tracking number for R1's refund check. they never denied not to issue a refund to R1. In addition, the facility stated during the conversation with R1's responsible party, staff gave the option either the electronic payment (It usually takes about 48-72 hours) or the check request (It usually takes about 15 days) for R1's refund but R1's responsible party decided the check request.

Based on interviews with residents and staff and documents reviewed, 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 is UNSUBSTANTIATED.

No deficiencies were observed or cited during today's visit.

An exit interview was conducted with Executive Director, Carla Mariano, and a copy of the report was provided.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

LIC9099 (FAS) - (06/04)

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