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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700265
Report Date: 10/12/2022
Date Signed: 10/12/2022 01:40:24 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/10/2022 and conducted by Evaluator Kevin Mknelly
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20221010152111
FACILITY NAME:OASIS FOR SENIORS AT HEAVEN'S GARDENFACILITY NUMBER:
312700265
ADMINISTRATOR:TODEREAN, ADELAFACILITY TYPE:
740
ADDRESS:6203 TWO TOWERS COURTTELEPHONE:
(916) 781-9179
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:6CENSUS: 6DATE:
10/12/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Adela TodereanTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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The licensee did not use an approved addmission agreement.
Licensee failed to refund resident representative as required.
Licensee increased fees without proper notice to resident/ representative.
INVESTIGATION FINDINGS:
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On 10/12/22, Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced to open this complaint onvestigation. The investigation was also concluded based on evidence collected, delivered complaint findings. LPA met with the Licensee and explained the purpose of the visit. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA completed a facility risk assessment upon arrival. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility. LPA advised more thorough screening of visitors be documented.

The department reviewed client/resident records provided by the reporting party and verifed information with the licensee during an interview.
The department finds that the allegations cited above are substantiated. Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
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 4
Control Number 25-AS-20221010152111
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: OASIS FOR SENIORS AT HEAVEN'S GARDEN
FACILITY NUMBER: 312700265
VISIT DATE: 10/12/2022
NARRATIVE
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R1 was admitted on or about 3/1/22. At the time of the admission, the agreed upon fee was $6500, plus a one time fee of $650. During the month of March, R1 was hospitalized, had a change of condition and returned to the facility on Hospice. R1's monthly fees were increased to $7000 due to what the licensee determined were increase level of care.

LPA reviewed licensee's admission agreement and found: The admission agreement used by the licensee is not the same as the approved admission agreement on file with the Department; The admission agreement in use at the home and used with R1 has a sliding scale for the first month of residents admitted on hospice; LPA and licensee reviewed a copy of another resident's admission agreement (R1's file is not present- LPA to receive a copy), the admission agreement also contains a one time admission fee of $650 without a written general statement describing all costs associated with the preadmission fee charges and stating that the preadmission fee is refundable, and describing conditions for the refund.
Licensee will submit copies of R1's LIC 602, appraisal, hospice assessment and admission agreement.

In the interview with the licensee and in review or the admission agreement in use, it was found that the licensee does not have a level of care fee schedule as part of the admission agreement.

From a review of the evidence it is found that R1 was wrongly charged an additional $500 for April- June 2022, or $1500. Additionally, R1 passed away and belongings were removed by 6/24/22. That amounts to $233 x 6 day= $1398. Therefore, the total reimbursement owed R1 is $2,898.

It should be known that it was evident during discussions with the licensee that they did not appear to be acting in bad faith. There errors in assessment of fees appears to have been on the advice of others than Community Care Licensing. The licensee does not contest the error and is very cooperative toward resolving the issue and re-establishing regulation compliance.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.
Report reviewed with licensee . Copy of this report and appeal rights provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 25-AS-20221010152111
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: OASIS FOR SENIORS AT HEAVEN'S GARDEN
FACILITY NUMBER: 312700265
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/09/2022
Section Cited
CCR
87208(a)
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Plan of Operation. Each facility shall have and maintain a current..plan of operation. ... Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. This requiremtn was not met based on records review and interview finding a admission agreement in use not approved by CCL. This posed a potential risk to personal rights
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Licensee will submit the admission agreement that they wish to use, if different than on file, to CCL by the POC date of 11/9/22.
Type B
10/27/2022
Section Cited
HSC
1569.652(c)
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Termination of admission agreement upon death of resident...- (c) A refund of any fees paid in advance... shall be issued to the individual... within 15 days after the personal property is removed. This requirement was not met based on documents and statements that fees were insufficient and exceeded 15 days.
This posed a risk to personal rights.
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Licensee will submit proof of reimbursement agreed to with R1's spouse, not to exceed $2,898, by rhe POC date of 10/27/22
Request Denied
Type B
10/27/2022
Section Cited
CCR
87507(g)(4)(B)
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Admission Agreements.(g)(4)(B)The conditions under which a licensee may increase or change rates shall be specified in the admission agreement. Records found that level of care increases are not identified in the admission agreement yet were charged to R1. This posed a potential risk to personal rights.
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Licensee will submit a statement of understanding of this requirement. The statement will contain that no other residents are currently charge level of care fees and that should the licensee develop level of care fees, it will be submitted for approval to CCL
POC due 10/27/22
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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.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/10/2022 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 25-AS-20221010152111

FACILITY NAME:OASIS FOR SENIORS AT HEAVEN'S GARDENFACILITY NUMBER:
312700265
ADMINISTRATOR:TODEREAN, ADELAFACILITY TYPE:
740
ADDRESS:6203 TWO TOWERS COURTTELEPHONE:
(916) 781-9179
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:6CENSUS: 6DATE:
10/12/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Adela TodereanTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Licensee charged a resident for services not shared during intake.
INVESTIGATION FINDINGS:
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On date) at (time AM/PM), Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with clinical staff. Prior to initiating the complaint visit, LPA completedthe department's required COVID-19 protocols

LPA conducted records review and interviews.
LPA is unable to find and or meet the preponderance, per policy.

LPA was unable to determine what was stated between R1, their family and the licensee before the admission date and signing of the admission agreement. Therefore the department responded to fees charged and the admission agreement signed for the duration of R1's stay.

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview with administrator.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4