306006360-10-6-2023-22-AS-MVAO-CYYRBF-20231229115239

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006360
Report Date: 10/06/2023
Date Signed: 10/06/2023 01:26:43 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/04/2023 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231004114033

FACILITY NAME:	WATERMARK LAGUNA NIGUEL		FACILITY NUMBER:	306006360
ADMINISTRATOR:	THARP, CHRISTOPHER		FACILITY TYPE:	740
ADDRESS:	27762 FORBES ROAD		TELEPHONE:	(520) 797-4000
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY:	135	CENSUS: 3	DATE:	10/06/2023
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Christopher Tharp, Deanna Davenport		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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9

Staff did not issue a refund

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Executive Director Christopher Tharp and explained the reason for the visit. The investigation revealed the following. It was reported that Resident 1 did not receive a refund for their reservation fee of $2500.00. Resident 1 never moved into the facility but a pre-appraisal was conducted. Resident 1 reported that they were informed that they would receive a full refund. LPA interviewed staff who corroborated this report. LPA reviewed facility documents which show a refund has been processed but not issued. At the time of this report the refund has not been issued and Resident 1 has not received a refund. Based on the evidence gathered, the preponderance of evidence standard has been met, therefore the allegation is substantiated. Violations are being cited per California Code of Regulations, Title 22 division 6. An exit interview was conducted and a copy of the report and appeals rights was provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

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 22-AS-20231004114033

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WATERMARK LAGUNA NIGUEL	FACILITY NUMBER: 306006360
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/06/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/16/2023 Section Cited CCR 87507(g)(5)(E)(2)(a)	1 2 3 4 5 6 7	A refund of at least 80 percent of the preadmission fee in excess of $500 shall be provided if the applicant does not enter the facility after a preadmission appraisal is conducted, or the resident leaves the facility for any reason during the first month of residency. This requirement was not met	1 2 3 4 5 6 7	Licensee agrees to issue a refund to Resident 1 in the amount of $2500.00 by 10/16/23. LIcensee to forward proof to LPA by POC due date.
	8 9 10 11 12 13 14	as evidenced by. According to a document review and witness interviews a refund was not issued to Resident 1 for their reservation fee. This poses a potential harm to the resident.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC9099 (FAS) - (06/04)

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