331800100-4-10-2025-56-AS-EMAN-DFUPEU-20250418111542

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800100
Report Date: 04/10/2025
Date Signed: 04/10/2025 03:22:23 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/02/2025 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20250402104857

FACILITY NAME:	GENEROUS HOMECARE		FACILITY NUMBER:	331800100
ADMINISTRATOR:	LIBED, MARIE ANTONETTE		FACILITY TYPE:	740
ADDRESS:	31963 GOLDEN WILLOW COURT		TELEPHONE:	(951) 467-0366
CITY:	WINCHESTER	STATE: CA	ZIP CODE:	92596
CAPACITY:	6	CENSUS: 2	DATE:	04/10/2025
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Licensee/Administrator Marie Libed		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not provide a refund upon resident’s death.

INVESTIGATION FINDINGS:

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On 04/10/2025 at 03:00 PM, Licensing Program Analyst (LPA) Melody Brown met with Licensee/Administrator Marie Libed at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) San Bernardino (SB) Regional Office (RO) to deliver the findings of the above allegation. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of records review and interviews with relevant parties.

The investigation was conducted by LPA Melody Brown which consisted of interview with relevant parties and review of records. The allegation indicates staff did not provide a refund upon resident’s death. During the investigation, LPA Brown was not able to obtain sufficient evidence to corroborate the allegation. LPA Brown interviewed Resident # 1 (R1) family member and R1 family member confirmed that they were informed of R1's Admission Agreement indicating "No Refund for Hospice Resident" and they signed it. Interview with Staff #1 (S1) indicated that on 01/31/2025, S1 explained the "No Refund for Hospice Resident" written in R1's Admission Agreement at the facility ***Continuation in LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

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 56-AS-20250402104857

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: GENEROUS HOMECARE	FACILITY NUMBER: 331800100
	VISIT DATE: 04/10/2025

NARRATIVE

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and R1's family member verbalized understanding and signed R1's Admission Agreement. Records Review revealed that R1's Admission Agreement indicated “No Refund for Hospice Resident" and R1 family member and S1 both signed it on 01/31/2025 when R1 moved-in at the facility.

Therefore, based on the evidence obtained during LPA Brown's investigation, there is insufficient evidence to prove staff did not provide a refund upon resident’s death is UNSUBSTANTIATED at this time. Although the allegation of staff did not provide a refund upon resident’s death may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time.

An exit interview was conducted where this report (LIC9099), was discussed and provided to Licensee/Administrator Marie Libed.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

LIC9099 (FAS) - (06/04)

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