198603310-5-10-2023-11-AS-JHAD-CSTUFT-20230615153316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603310
Report Date: 05/10/2023
Date Signed: 05/10/2023 01:00:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/10/2023 and conducted by Evaluator Jeremiah Randle

COMPLAINT CONTROL NUMBER: 11-AS-20230210141143

FACILITY NAME:	MIRACLE MILE MANOR RCFE		FACILITY NUMBER:	198603310
ADMINISTRATOR:	NAGEL, EDITH		FACILITY TYPE:	740
ADDRESS:	6273 DEL VALLE DRIVE		TELEPHONE:	(323) 807-0549
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90048
CAPACITY:	6	CENSUS: 6	DATE:	05/10/2023
		UNANNOUNCED	TIME BEGAN:	10:52 AM
MET WITH:	Edith Nagel Administrator		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Staff did not refund resident

INVESTIGATION FINDINGS:

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On 5/10/2023 Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced subsequent complaint investigation at the facility listed above. LPA arrived at facility and was greeted by Edith Nagel Administrator (S1) LPA explained the purposed of the visit is to deliver findings on the allegation listed above.

The investigation consisted of the following:
LPA Randle toured facility, LPA requested pertinent documents pertaining to the investigation. The following documents were gathered: Staff and Client Rosters, file for resident (R1) including admission agreement and any other pertinent documentation regarding R1. LPA reviewed facility files and interviewed staff (S1), Resident (R1) was not interviewed R1 was not at the facility R1 returned home, further R1’s agreement was entered into by R1’s daughter (CW1). LPA did interview (CW1). LPA requested, received, and reviewed the following information: file of R1, Staff roster, Resident roster, and other documents relevant to the investigation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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 11-AS-20230210141143

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: MIRACLE MILE MANOR RCFE	FACILITY NUMBER: 198603310
	VISIT DATE: 05/10/2023

NARRATIVE

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Investigation Revealed the following.

Allegation: Staff did not refund resident

LPA conducted an interview with S1, S1 denies the allegation. S1 informed LPA that all prorated rent monies are refunded to residents in a timely manner if due. S1 stated there are no residents, that S1 is aware of, that have not received a refund that is due. S1 also stated to LPA that R1 or (CW1) is not entitled to receive a refund for the days residing at the facility. S1 stated that R1 was receiving basic service for three months as requested by CW1. S1 stated that (CW1) signed the agreement within the scope of the agreement there contains a 30-day notice clause when leaving the facility. LPA interviewed CW1, CW1 provided a signed copy of the agreement signed by CW1 containing the 30-day notice clause. CW1 did not provide a power of attorney to LPA, however CW1 was acting as R1’s representative. CW1 stated that she was under the impression that there was a three-month minimum charge for residing at the facility. CW1 stated R1 left the facility after receiving a bill for the beginning of the fourth month of residency which was not paid by CW1 per S1, thus leaving a balance due to the facility per S1. LPA reviewed the records.

Based on information gathered, the department did not find sufficient evidence to support the allegation. 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.

An exit interview was conducted and a copy of the LIC 9099 was provided to Edith Nagel Administrator.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC9099 (FAS) - (06/04)

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