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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603648
Report Date: 11/18/2024
Date Signed: 11/18/2024 04:18:49 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
11/13/2024 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20241113112200
FACILITY NAME:OMEO ARCADIA LIVINGFACILITY NUMBER:
198603648
ADMINISTRATOR:ZHANG, JINGFANGFACILITY TYPE:
740
ADDRESS:601 SUNSET BLVDTELEPHONE:
(323) 422-8030
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:99CENSUS: 80DATE:
11/18/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Lucy Alonso, administrator assistantTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Wrongful eviction.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation for the allegation listed above. LPA met Administrator assistant, Lucy Alonso and spoke with administrator Jennifer Lan over the phone to explain the purpose of today's complaint investigation visit.

The investigation consisted of the following: LPA obtained staff/resident roster, interviewed residents from resident#1 (R1) to resident#6 (R6), interviewed staff from staff#1 (S1) to staff#3 (S3), and conducted a physical plant.

The investigation revealed the following:
In regard of the allegation of wrongful eviction, it was alleged that the facility issued an eviction notice to a resident due to rent non-payment. The facility charged that resident with private room rate instead of Assisted Living Waiver (ALW) program rate for the month of October even though resident was admitted to ALW program since Sept 2024. (-continued on LIC9099C-)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
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 3
Control Number 28-AS-20241113112200
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: OMEO ARCADIA LIVING
FACILITY NUMBER: 198603648
VISIT DATE: 11/18/2024
NARRATIVE
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Per residents’ interviews, all six (6) residents could not corroborate the allegation. It revealed residents were not aware of any evictions taking place at the facility or any missing ALW payments on their paying their rents. All three (3) staff interviewed denied the allegation. Staff interviews revealed that, a few weeks ago, staff attempted to file claims to get ALW to pay the resident’s non-pay rent for August 2024 to Oct 2024, but ALW denied all claims due to resident's insurance change and the insurance company was not approved by ALW program. Per record review, staff reported resident’s non-pay monthly rent from Aug 2024 to Oct 2024 were on private room rates. Per ALW waiver record, the resident was admitted to ALW since Sept 1, 2024. Therefore, the facility should charge resident’s room with ALW rate for the month of Sept and Oct 2024; however, the facility charged the resident with private room rate plus medical management fee on Oct 2024 rent.

Based on LPA's observations, record reviews and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found SUBSTANTIATED.

Deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8 on LIC 9099D.

An exit interview was conducted with Lucy, administrator assistant. A hard copy of this reports and appeal right were provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20241113112200
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: OMEO ARCADIA LIVING
FACILITY NUMBER: 198603648
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/21/2024
Section Cited
CCR
87224(a)(1)
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(a)(1) Nonpayment of the rate for basic services…

The requirement is not met by evidence of:

The facility charged an ALW resident with private room rate in Oct 2024.
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Licensee agreed to file claims to ALW to obtain resident’s non pay rent payments and provide a copy of the rent invoices to show ALW had made the payments for resident by POC due date. Licensee provide the proof of the repair to Licensing.
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Rent rate was above the basic services stated in the admission agreement and ALW program rate. The facility should not evict the resident. Based on interviews and observation, the Administrator did not comply with the section cited above which poses 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.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3