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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603648
Report Date: 12/10/2024
Date Signed: 12/10/2024 03:44:36 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: 79DATE:
12/10/2024
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Jennifer Lan, administratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Wrongful eviction.
INVESTIGATION FINDINGS:
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***This report serves as an amendment and supersedes the original complaint investigation report created on 10/25/24. The finding remained as substantiated. ***

Licensing Program Analyst (LPA) Tao conducted a subsequent unannounced complaint investigation for the allegations listed above today. LPA met Jennifer Lan, Administrator and explained the purpose of today's visit.

On 11/18/24, the initial investigation visit was conducted. Today, LPA Tao conducted a subsequent 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: (-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: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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: 12/10/2024
NARRATIVE
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***This report serves as an amendment and supersedes the original complaint investigation report created on 10/25/24. The finding remained as substantiated. ***

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-payments. 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.

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 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 program to pay for the resident’s non-payment of rents for August 2024 through October 2024. However, the ALW program denied all claims for monthly rent due to the change of resident's insurance because the resident’s insurance company was not approved by ALW program. Per LPA’s review of resident records and staff interviews, staff reported resident’s non-payment of monthly rents from August 2024 through October 2024 was based on the facility’s private room rates and not on the ALW program’s monthly rates. Per the resident’s admission agreement dated 09/01/23, the facility admitted the resident to the facility and charged the ALW program rate. The ALW program admission’s letter indicates the resident was admitted to ALW program effective on 09/01/23. Per the resident’s admission agreement, it stated the resident’s rent rate was based on the ALW program rate. However, the facility changed the monthly rate to private pay rate and charged the resident at the private room rate from August to October 2024 which were the said nonpayment. As a result, the facility wrongfully issued an eviction notice to the resident for nonpayment at the private pay rate for August, September, and October 2024. Additionally, on November 18, 2024, LPA Tao provided the facility with a copy of the notice dated 10/09/23, from the ALW program regarding the resident being admitted to the ALW Program on 09/01/23.

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 administrator. 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: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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: 12/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2024
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. Rent rate was charged above the rate stated in the
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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. Resident's eviction should be canceled.
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admission agreement and ALW program rate. The non-payment of rent was not valid, thus, should not evict 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: 12/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
LIC9099 (FAS) - (06/04)
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