331800083-6-24-2024-18-AS-JDHS-D74TE2-20240712143910

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800083
Report Date: 06/24/2024
Date Signed: 06/24/2024 09:10:04 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/31/2023 and conducted by Evaluator Jacqueline Shaw Ross

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20231031153951

FACILITY NAME:	RENAISSANCE VILLAGE MURRIETA		FACILITY NUMBER:	331800083
ADMINISTRATOR:	BRIAN TAUBE		FACILITY TYPE:	740
ADDRESS:	24271 JACKSON AVENUE		TELEPHONE:	(951) 319-8243
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92562
CAPACITY:	166	CENSUS: 88	DATE:	06/24/2024
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Juan Vergara, Business Office Manager		TIME COMPLETED:	09:10 AM

ALLEGATION(S):

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Staff did not provide a proper rate increase notice to the resident or the residents' representative.
Staff did not follow proper Pre-Admission Appraisal procedures.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jacqueline Shaw Ross conducted a visit to the facility and met with Juan Vergara, Business Office Manager. The purpose of the visit was to deliver findings for the above allegations. The investigation consisted of interviews with staff, clients, additional witnesses, and record review.

On 10/31/2023, Community Care Licensing received a complaint alleging the facility did not provide a proper rate increase notice to resident and did not follow proper pre-admission appraisal procedures. It was reported that Resident #1 or responsible party did not receive documentation regarding the rate increase. Information obtained from an interview with Executive Directors and Resident/Representative indicate the Admissions Agreement was read and reviewed prior to their signing and Resident/Representative was aware that there would be rate increases; however, it did not indicate the dates the increases would occur. Information obtained from interviews with Executive Directors Brian Kaupe and Janae Orona indicated they were not notified by upper management of the upcoming increase in level of care fees until after resident/representatives signed the agreement. Interview with additional witness indicate they were not informed of the upcoming increase in fees until after their signing of the Admissions Agreement. Record review revealed the Admission's Agreement was signed by the Resident's Responsible Party on 10/2/2023.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024

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 18-AS-20231031153951

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: RENAISSANCE VILLAGE MURRIETA	FACILITY NUMBER: 331800083
	VISIT DATE: 06/24/2024

NARRATIVE

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Record review also revealed a letter of increase in level of care fees was mailed to RP on 10/9/23 indicating the increase would take effect on 1/1/2024. Resident’s Responsible Party acknowledged receipt of the letter. Interview with Executive Directors report the increase was unintentional and representatives attempted to rectify the issue by delaying the increase of level of care by one year. It was advised that the increase for Resident would begin on 1/1/2025. Record review revealed this letter was mailed to all residents 60 days prior to the effective date of increase per program admissions agreement. Resident #1’s Responsible Party declined the offer and removed Resident #1 from the facility prior to the increase in fees.

Based on observation, interviews, and record review, the allegations that staff did not provide a proper rate increase notice to the resident/resident's representative, and that staff did not follow proper Pre-Admission Appraisal procedures is UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was provided to Juan Vergara, Business Office Manager.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024

LIC9099 (FAS) - (06/04)

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